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Mon Aug 6 04:28:45 BST 2007

As you look at the new techniques to monitor perfusion (NIR instead of BP,
etc), I would also look at some of the new work regarding slow reperfusion
protocols. Remember that it's not so much the lack of oxygen as much as the
sudden onrush of oxygen after deprivation that causes cell death (mostly via
free radicals, etc). These protocols are being intensely researched in
cardiovascular events, etc.; but I think this would apply to trauma, TBIs,
and any other state where tissue is exposed to hypoxia. Maybe in the future
patients will undergo permissive hypotension and slow reperfusion as opposed
to today's immediate massive reperfusion, 100% O2 masks,  etc.

Alex Garbino

On 8/5/07, KMATTOX at aol.com <KMATTOX at aol.com> wrote:
>
>
> In a message dated 8/5/2007 9:12:31 P.M. Central Daylight Time,
> ih7 at msn.com
> writes:
>
> What I  don't understand is why crystalloids help - they do not increase
> oxygen  delivery meaningfully..
> but they keep the BP and CO, - is that useful for  the body ?? Why ?
>
> What if we just keep up the BP and not the CO - by  using pressors
> ??  (now I
> am questioning the dogma).
> Would patients  become more acidotic and have low SvO2 more than with
> crystalloids  ?
>
>
>
>
> The BIG fallacy here is that we continue to assume that CO and BP are our
> objective of resuscitation.   WRONG.   Whether it be brain,  kidney, gut,
> or big
> toe preservation, it is perfusion and oxygen extraction that  is
> essential,
> with variables of temperature, pH, etc. altering the  exchange.     That
> is why
> NIR would be much better than the  BP cuff.     Whether it is MAST, drugs,
> crystalloids, or  position, any attempt to resuscitate based on BP as an
> end
> point simply is  living in the 1960s and not the 21st
> century.      Get  your
> head out of the past and into current thinking.   You need to go  no
> further than
> Karim Brohi's trauma.org pages to get an excellent review of  this
> subject.
>
> k
>
>
>
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Why are crystalloids better > pressors ?= NEITHER