Incidence, physiologic description, compensatory mechanisms, and therapeutic implications of monitored events.
We described 663 unanticipated monitored circulatory events in 247 high-risk surgical patients by simultaneous invasive and noninvasive hemodynamic and oxygen transport monitoring systems. Unanticipated monitored events were defined as sudden reductions (greater than 20%) in cardiac index (CI), PaO2, SaO2, transcutaneous PO2 (PtcO2), and PtcO2/PaO2 index, or decreases to the lower limits of satisfactory values, specifically: PaO2 less than 70 torr, SaO2 less than 95%, PtcO2 less than 50 torr, and PtcO2/PaO2 less than 0.6. Essentially, monitored events are the small variations superimposed on the overall physiologic patterns that describe the entire course of critical illnesses. Monitored events are described by their baseline values just before each event, at the nadir of the event, and at the recovery from the event. To simplify presentation of complex changes in many variables, the circulatory changes were evaluated in terms of cardiac, pulmonary, and peripheral perfusion functions. Common patterns of these monitored events and the incidence of these patterns in high-risk surgical patients were described. Before the unanticipated monitored event, there were normal or increased heart, lung, and perfusion functions in about three fourths of the events. At the nadir, cardiac functions decreased in about two thirds, perfusion decreased in over half, and lung function fell in only one quarter of the events. Recovery occurred with increased cardiac function in two thirds, improved perfusion in over half, and increased lung function in less than one fifth of these monitored events. Noninvasive and invasive hemodynamic and oxygen transport variables were measured simultaneously to evaluate compensatory and decompensatory patterns.(ABSTRACT TRUNCATED AT 250 WORDS)
Shoemaker
W C
WC
Department of Surgery, King Drew Medical Center, Los Angeles, CA.
Appel
P L
PL
Kram
H B
HB
D001784:Blood Gas Analysis / Q000379:methods; D002302:Cardiac Output; D002319:Cardiovascular System / Q000503:physiopathology*; D003936:Diagnosis, Computer-Assisted; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D010092:Oximetry / Q000379:methods; D010101:Oxygen Consumption; D011183:Postoperative Complications / Q000503:physiopathology*; D013815:Thermodilution