title: [Acute heart insufficiency of primarily non-cardiac origin after polytrauma].
abstract: The following approach is proposed for treatment of the hemodynamics resulting from severe trauma. Blood pressure and pulse frequency are measured whilst volume is added until peripheral circulation returns to normal or until CVP attains 13 mm Hg (under CPPV, PEEP 10 cm H2O). When CVP attains 13 mm Hg a pulmonary-arterial thermodilution catheter is introduced and transfusion continued, possibly up to a PCWP of 17 mm Hg. At this stage, 4 different haemodynamic groups may be distinguished and are described on the basis of the mean values recorded for 3 patients in each group: 1. SVRI increased, LVSWI and PVRI normal.
  
  
  METHODS
  continued slow addition of volume. 2. SVRI and PVRI slightly elevated. LVSWI diminished. CI and VO2 adequate.
  
  
  METHODS
  phentolamine. 3. PVRI slightly elevated, CI and VO2 too low, i.e. left cardiac insufficiency.
  
  
  METHODS
  isuprel. 4. PVRI markedly elevated, CI and VO2 clearly diminished, i.e. biventricular cardiac insufficiency with pulmonary-vascular hypertension.
  
  
  METHODS
  isuprel and phentolamine. Pharmacological therapy can be discontinued after a few days and hemodynamics remain normal. These observations show that "acute cardiac failure in fundamentally normal hearts" can occur after severe trauma and that treatment is possible.
mesh_terms: D001810:Blood Volume / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007545:Isoproterenol / Q000627:therapeutic use; D010646:Phentolamine / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D002316:Cardiotonic Agents; D007545:Isoproterenol; D010646:Phentolamine
vernacular_title: Akute Herzinsuffizienz nicht primär kardialer Genese nach Polytrauma.