76
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Clark SL, Greenspoon JS, Aldahl D, Phelan JP. Severe preeclampsia with persistent oliguria: management of hemodynamic subsets. Am J Obstet Gynecol 1986; 154:490-4. [PMID: 3953696 DOI: 10.1016/0002-9378(86)90588-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nine patients with severe preeclampsia or eclampsia complicated by persistent oliguria failed to respond to fluid challenge and underwent pulmonary artery catheterization to guide further fluid and hemodynamic management. Three hemodynamic subsets of patients were defined. Patients in category I had low pulmonary capillary wedge pressure, hyperdynamic ventricular function, and moderate elevation of systemic vascular resistance. These patients responded to volume infusion with a decline in systemic vascular resistance, a rise in wedge pressure and cardiac output, resolution of oliguria, and no change in blood pressure. Patients in category II had normal or elevated pulmonary capillary wedge pressure and cardiac output and normal systemic vascular resistance; they responded to pharmacologic preload and/or afterload reduction. A single patient (category III) exhibited markedly elevated wedge pressure and systemic vascular resistance and depressed ventricular function. Oliguria in this patient responded to volume restriction and aggressive afterload reduction. Hemodynamic observations in patients in category II imply the presence of selective vasodilator responsive renal arteriospasm in some preeclamptic patients with oliguria.
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77
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Zandvliet X, Gouda P, Lievaart A, Sol T. [Continuous arteriovenous hemofiltration]. TIJDSCHRIFT VOOR ZIEKENVERPLEGING 1986; 39:98-102. [PMID: 3634530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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78
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Flores JC, Taube D, Savage CO, Cameron JS, Lockwood CM, Williams DG, Ogg CS. Clinical and immunological evolution of oligoanuric anti-GBM nephritis treated by haemodialysis. Lancet 1986; 1:5-8. [PMID: 2867295 DOI: 10.1016/s0140-6736(86)91893-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eight patients with oligoanuric anti-glomerular-basement-membrane (GBM), antibody-mediated glomerulonephritis without lung haemorrhage who were not treated with plasma exchange therapy were reviewed. All had severe crescentic nephritis and required dialysis. Circulating anti-GBM antibodies disappeared gradually and spontaneously in all patients. The autoantibodies became undetectable in five patients after an average of 11 months. No patient recovered renal function. Two patients have been successfully transplanted and anti-GBM nephritis has not recurred. One of these needed a pre-transplant course of plasma exchange and immunosuppression to reduce a slightly raised anti-GBM antibody titre. Of five patients who remain on dialysis, only two cannot be transplanted due to the persistence of circulating autoantibodies. One patient died from causes unrelated to renal disease. Oligoanuric patients with anti-GBM nephritis who need dialysis rarely benefit from aggressive therapy unless lung haemorrhage is present.
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79
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Lattanzi WE, Siegel NJ. A practical guide to fluid and electrolyte therapy. CURRENT PROBLEMS IN PEDIATRICS 1986; 16:1-43. [PMID: 3079690 DOI: 10.1016/0045-9380(86)90026-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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80
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Nicholson GD. Cessation of regular haemodialysis therapy in oliguric malignant hypertension treated with minoxidil. W INDIAN MED J 1985; 34:268-73. [PMID: 4090474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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81
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Zolotokrylina ES, Ivunina OG, Terenkova GP. [Differential diagnosis and treatment of disorders of kidney excretory function and acute kidney failure in the post-resuscitation period in patients with massive blood loss and trauma]. ANESTEZIOLOGIIA I REANIMATOLOGIIA 1985:44-8. [PMID: 4051239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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82
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Baxter P, Rigby ML, Jones OD, Lincoln C, Shinebourne EA. Acute renal failure following cardiopulmonary bypass in children: results of treatment. Int J Cardiol 1985; 7:235-43. [PMID: 3980127 DOI: 10.1016/0167-5273(85)90047-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Following open heart surgery using cardiopulmonary bypass, 18 (4%) of 441 operated children required treatment with peritoneal dialysis for acute renal failure or refractory oliguria. Nine recovered renal function (50%) and 5 (28%) survived. Only 2 died from renal causes. Despite both adequate symptomatic treatment of renal failure and few complications of dialysis itself, the prognosis remains poor, even with early treatment, but an aggressive approach is justified because some survivors can be expected.
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83
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Keller F, Wagner K, Lenz T, Pommer W, Hahn G, Molzahn M, Krause PH. Haemodialysis in 'hepatorenal syndrome': report on two cases. Gut 1985; 26:208-11. [PMID: 3967839 PMCID: PMC1432414 DOI: 10.1136/gut.26.2.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report two patients with hepatorenal syndrome who recovered from oliguria and renal failure after temporary treatment with haemodialysis. Hepatorenal syndrome developed under diuretic treatment in both patients. Volume expansion, dopamine, and prostaglandin I2 did not improve renal function. In the one patient with alcoholic cirrhosis, renal biopsy showed only minimal alterations of glomeruli, tubuli, and arterial vessels. In the other case, the deterioration and improvement in renal function parallelled changes in acute alcohol-toxic hepatic function. We conclude that haemodialysis should be considered for treatment of hepatorenal syndrome in selected patients where reversal of liver failure can be expected.
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84
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Heinsohn ME, Epstein AE, Katholi RE. Transient paradoxical renal vasoconstriction following cardiac operation. Treatment with volume depletion. Chest 1985; 87:257-8. [PMID: 3871387 DOI: 10.1378/chest.87.2.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Following cardiac operation complicated by inferior myocardial injury, a patient developed normal cardiac output congestive heart failure associated with severe renal vasoconstriction, oliguria and azotemia. The patient's renal dysfunction responded to volume depletion with hemofiltration. These paradoxical renal responses to volume changes may be caused by transiently altered cardiac volume receptor thresholds or afferent signals resulting in cardiorenal dysfunction.
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85
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ten Berge IJ, Wilmink JM, Meyer CJ, Surachno J, ten Veen KH, Balk TG, Schellekens PT. Clinical and immunological follow-up of patients with severe renal disease in Wegener's granulomatosis. Am J Nephrol 1985; 5:21-9. [PMID: 3881957 DOI: 10.1159/000166898] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical and immunological data are reported of 12 patients suffering from Wegener's granulomatosis and severe renal involvement. Although 9 patients recovered from their acute illness, a long-term follow-up a relapse occurred in 4 of these 9 patients. Therefore, lifelong follow-up in this group patients seems to be mandatory. Extensive immunological investigations did not provide evidence for humoral mechanisms underlying the pathogenesis of this disease; T lymphocyte subsets in peripheral blood as well as functional reactivity of lymphocytes in vitro were also normal. However, none of the patients was able to mount a primary cellular immune response in vivo. On the other hand, kidney biopsy specimens obtained before the initiation of drug therapy revealed periglomerular and interstitial cellular infiltrations consisting predominantly of T lymphocytes with a ratio Leu 3a (OKT4)/Leu 2a (OKT8) of 5:1. This may indicate that a type IV (delayed-type) hypersensitivity reaction takes place in the kidney. These findings suggest that an abnormal cellular immunoreactivity plays a major role in the pathogenesis of Wegener's granulomatosis.
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86
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Hegeman TF. Oliguria: a frequent problem in the critically ill patient. INDIANA MEDICINE : THE JOURNAL OF THE INDIANA STATE MEDICAL ASSOCIATION 1984; 77:864-5. [PMID: 6512244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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87
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Fort J, Espinel E, Rogriquez JA, Curull V, Madrenas J, Piera L. Partial recovery of renal function in an oligoanuric patient affected with Goodpasture's syndrome after treatment with steroids, immunosuppressives and plasmapheresis. Clin Nephrol 1984; 22:211-2. [PMID: 6509807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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88
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Alpert RA, Roizen MF, Hamilton WK, Stoney RJ, Ehrenfeld WK, Poler SM, Wylie EJ. Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization. Surgery 1984; 95:707-11. [PMID: 6427960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To determine whether intraoperative urinary output was predictive of postoperative renal function, mean urinary output and lowest hourly urinary output were measured in 137 patients during operation for aortic reconstruction. Pulmonary capillary wedge pressure was kept within normal limits. If urinary output was less than 0.125 ml X kg-1 X hr-1, patients were given crystalloid solution, mannitol, furosemide (Lasix), or nothing. For each patient, serum creatinine and blood urea nitrogen (BUN) levels were assayed on postoperative days 1, 3, and 7. There was no significant correlation between intraoperative mean urinary output or lowest hourly urinary output and change from preoperative to postoperative levels of creatinine or BUN. Twenty-one patients had postoperative renal insufficiency; of these, 17 had had renal disease before operation. In these patients as well; mean urinary output and the lowest hourly urinary output did not correlate with change in BUN or creatinine levels. The position of the aortic cross-clamp did not affect these correlations. Therefore, intraoperative urinary output was not predictive of postoperative renal insufficiency in patients undergoing aortic reconstruction.
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89
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Siegel NJ, Gaudio KM. Disorders of urine volume in the critically ill child. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 1984; 57:29-47. [PMID: 6375163 PMCID: PMC2589616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article will provide a pathophysiologic basis for the assessment of critically ill children who have developed disorders of urine volume. The anatomical and pathophysiologic causes of oliguria and polyuria are considered. The physiologic basis for the use of urinary sodium and osmolarity as a guide to the assessment of patients with disorders of urine volume are discussed in detail. In addition, guidelines for the management of children with acute renal failure, with particular emphasis on the consideration for nutritional support of these patients, is discussed as a part of the comprehensive approach to this problem. This article emphasizes an understanding of the pathophysiology of salt and water excretion by the kidney as a foundation to the diagnosis and management of patients with oliguria and polyuria.
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90
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Ojogwu LI. Peritoneal dialysis in the management of hypertensive acute oliguric renal failure. TROPICAL AND GEOGRAPHICAL MEDICINE 1983; 35:385-8. [PMID: 6670124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Twenty consecutive patients admitted because of severe hypertension and uraemia were offered the benefit of intermittent peritoneal dialysis as an adjunct to hypotensive therapy. The outcome of this modality of treatment showed that despite the adequate control of severe hypertension all the patients remained oliguric and died from uraemia. It is concluded that short term intermittent peritoneal dialysis merely prolongs life for a few days or weeks and does not appear to be the answer to the problem of management of uraemia due to hypertension. An attempt must be made to provide facilities for regular haemodialysis and transplant surgery in developing countries.
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91
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Dodd NJ, O'Donovan RM, Bennett-Jones DN, Rylance PB, Bewick M, Parsons V, Weston MJ. Arteriovenous haemofiltration: a recent advance in the management of renal failure. BRITISH MEDICAL JOURNAL 1983; 287:1008-10. [PMID: 6412926 PMCID: PMC1549594 DOI: 10.1136/bmj.287.6398.1008] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Twenty five patients with oliguric renal failure were treated by a combination of continuous arteriovenous haemofiltration and intermittent haemodialysis over 18 months. Haemofiltration was given for a mean of 6.6 days and the mean filtration volume was 6.0 1/day. Fourteen of the 25 patients survived beyond two months after the period of oliguria. Haemofiltration proved to be a simple and effective method of fluid removal; it allowed maintenance of stable fluid balance and permitted optimum nutrition during prolonged oliguria.
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92
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Togashi K, Matsukawa T, Eguchi S. [Dialysis prior to oliguria in acute renal failure following open heart surgery]. [ZASSHI] [JOURNAL]. NIHON KYOBU GEKA GAKKAI 1983; 31:1397-406. [PMID: 6668439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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93
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Shiikawa A, Misumi H, Sawatari K, Ishihara K, Tsutsui T, Endo M, Koyanagi H, Aosaki M. [Surgical management and hemodialysis of septal perforation following myocardial infarct with oliguria]. [ZASSHI] [JOURNAL]. NIHON KYOBU GEKA GAKKAI 1983; 31:1298-302. [PMID: 6644132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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94
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Sibbald WJ, Calvin JE, Holliday RL, Driedger AA. Concepts in the pharmacologic and nonpharmacologic support of cardiovascular function in critically ill surgical patients. Surg Clin North Am 1983; 63:455-82. [PMID: 6407128 DOI: 10.1016/s0039-6109(16)42991-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The critically ill surgical patient requires close clinical, biochemical, and hemodynamic monitoring to define the right timing as well as the proper type of therapeutic intervention. Although many factors are available for monitoring, O2 delivery and extraction are two of the most important, since the enhanced metabolic demands of the stressed patient dictate a need to maintain greater than normal values to ensure survival. In other situations, primary therapy of the blood pressure, the PCWP, or other indices may take temporary precedence in the choice of therapeutic agents. Regardless of the means used to optimize O2 delivery, scrutiny of the consequences of therapy is equally important. Above all, any therapeutic intervention does not negate the need to treat the primary underlying process expeditiously.
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95
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Rigolot JC. [Management of postoperative oligo-anuria]. CAHIERS D'ANESTHESIOLOGIE 1982; 30:965-975. [PMID: 6927169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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96
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Stokke T, Kramer P, Schrader J, Gröne HJ, Burchardi H. [Continuous arteriovenous hemofiltration (CAVH)]. Anaesthesist 1982; 31:579-83. [PMID: 7181083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The continuous arteriovenous haemofiltration (CAVH) is a simple, safe, inexpensive and personnel-saving method for treatment of uremic patients. Since the introduction of the CAVH in 1977, far more than 200 patients have been treated by this method in our hospital. In the present paper the method and our experiences during the clinical application are presented. The haemofilter is placed in an extracorporal shunt between the A. and V. femoralis. Cannulation of these vessels is performed by means of a modified Seldinger technique using commercially available catheter. During haemofiltration, heparin is infused into the arterial blood line at a rate of 10 IU/kg . h. The filtrate is totally or partially replaced by nutrition solutions, enteral or parenteral, and by a potassium-free Ringer's lactate i.v. solution, according to the required fluid balance. In most cases the filtrate-substitution rate will be high enough to compensate renal failure, and thus conventional dialysis methods will not be necessary. Clinical experience to date allows the following conclusions: optimal control of water and electrolyte balance; unlimited parenteral nutrition, continuous fluid withdrawal better tolerated than intermittent withdrawal by means of dialysis; low risk of local bleeding with skilled puncture technique of the femoral vessels. Low dose continuous heparin administration into arterial blood line is sufficient for extracorporal anticoagulation. Saving of expenses: No investment costs for machines; specially trained dialysis personnel superfluous.
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97
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Mikhal'chuk MA, Buchko VM, Voĭtiatskiĭ VB, Ivanovskaia GM. [Treatment of the positional compression syndrome]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 1981; 126:71-6. [PMID: 7269115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The experience with the treatment of 35 patients with the syndrome of positional compression is described, 29 of then having acute renal insufficiency. They were subjected to 116 operations of hemodialysis. Five patients died. The main caused of the death was acute renal insufficiency. The measures used for the prevention of acute renal insufficiency are considered by the authors to be ineffective while the timely treatment by hemodialysis can result in recovery almost in all the cases. The main cause of failure of the treatment of this type of acute renal insufficiency was hyperhydration of the pulmonary tissue.
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98
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Kartasheva VI, Sorokina MI. [Acute kidney failure in lupus nephritis in children and adolescents]. PEDIATRIIA 1981:34-7. [PMID: 7255026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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99
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Lawson JE, Migdal SD, Rosenberg JC, Mc Donald FD. Recovery following prolonged postoperative renal failure. THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION 1981; 80:403-4. [PMID: 7263328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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100
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Gerrick SJ, Ledgerwood AM, Lucas CE. Postresuscitative hypertension: a reappraisal. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 1980; 115:1486-90. [PMID: 7447693 DOI: 10.1001/archsurg.1980.01380120054013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
New concepts of cause and therapy for postresuscitative hypertension (PRH) were evaluated in four patients with PRH. Each patient had severe injury and shock, and received an average of 28.3 transfusions, 15.4 L of electrolyte solution, and 1.4 L of plasma by the end of surgery for control of bleeding. Near the end of the sequestration phase, PRH developed. In two patients, PRH (190/100 mm Hg and 180/90 mm Hg) responded to previously recommended therapy; blood pressure fell to about 135/90 mm Hg. Shortly thereafter, bradycardia developed and both patients died. In the latter two patients, PRH (205/115 mm Hg and 150/120 mmHg) was treated less aggressively, maintaining intravenous fluids to keep urine output at a minimum of 50 mL/hr. Postresuscitative hypertension persisted for five and six days as both patients improved, continued to mobilize sequestered fluid, and maintained good organ perfusion. Postresuscitative hypertension may be a cell-mediated protective response to a need for increased capillary hydrostatic pressure to facilitate mitochondrial oxygenation. Fluid replacement should be guided by careful monitoring of cardiac, pulmonary, and renal function.
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