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• W2045216314 abstract "When only pressures and flow are examined, but not oxygen transport and oxygen consumption, crystalloids may appeart to be satisfactory, particularly in the elective patient who is not in shock. Body water shifts after hemorrhage, trauma and various combinations of these; proponents of the crystalloid school of thought believe reduced interstitial water (ISW) is the major problem in both hemorrhage and trauma, while others, who question the validity of 35SO4 as a measure of ISW, believe that the primary circulatory problem is hypovolemia. Sodium is known to increase arterial pressure and urine output; if these effects are used to test therapeutic efficacy; then sodium-rich solutions will be found to be effective even though they do not correct the essential defect of shock and trauma states.Fluid shifts have been described as either a “leak” or “equilibration” of the administered fluids according to the viewpoint of the observer. Irrespective of these interpretations, the net water shift in or out of the plasma volume has been measured before and after fluid therapy. In essence, crystalloids expand the ISW, as over 80% leaves the plasma before the end of the infusion; bu contrast, albumin increases plasma volume particularly in the early postoperative course of critically ill surgical patients. Blood volume expansion with massive volumes of crystalloids by virtue of the associated massive interstitial water expansion, may improve plasma volume, but this may also impede peripheral oxygen diffusion and worsen tissue oxygenation. In the postoperative shock patient, and the patient in early ARDS, blood volume and oxygen delivery are more effectively provided by colloids.Pulmonary edema may result from cardiogenic factors, noncardiac (ARDS) factors and excessive fluid administration. Salt and water restriction, diuretics and other supportive measures are usually indicated. When pulmonary edema is associated with hypovolemia, concentrated (25%) albumin may restore body water distribution by shifting fluid from the interstitium into the plasma volume. However, when pulmonary edema is due to interstitial pneumonitis, viral pneumonia and other medical causes of respiratory failure, the pulmonary capillay-alveolar membrane leak which usually occurs in the late stage of ARDS may be worsened by colloid therapy.Irrespective of philoscophical considerations of protagonists of a “partyline”, the critically ill, high risk patinnt should be monitored with sophisticated hemodynamic and O2 transport measurements in order to optimize the values of these variables to achieve maximum chances of survival." @default.
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• W2045216314 date "1984-01-01" @default.
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• W2045216314 title "Fluid therapy in shock and critical illness." @default.
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• W2045216314 doi "https://doi.org/10.3925/jjtc1958.30.246" @default.
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