Circulatory volume changes associated with chronic sepsis

Abstract

1. 1. Total blood volume, red blood cell mass, plasma volume, total serum protein, serum albumin, total body hematocrit, and large vessel hematocrit were studied in relation to the surgical treatment of young male patients with chronic septic states and weight loss due to primary intra-abdominal illnesses and to acute trauma sustained in the Republic of Vietnam. Marked reduction in red blood cell mass, total body hematocrit, and serum albumin was found with relatively minor deficits in total serum protein, large vessel hematocrit, total blood volume, and plasma volume. 2. 2. Antibiotic therapy based on appropriate cultures and transfusion with whole blood and packed red cells was employed liberally in sustaining these patients and preparing them for definitive surgical treatment. 3. 3. Recovery in these patients is dependent on adequate debridement of all infected tissues and drainage of abscesses. 4. 4. The abnormalities noted herein disappear once definitve surgical therapy has taken place. 5. 5. Despite conflicting statements in the surgical literature, we believe that this study supports the liberal use of preoperative transfusion therapy to correct the red blood cell deficit. With this program of measured replacement based on calculated normal values for the patients' normal weight, no untoward effects were noted and the incidence of marked operative hypotension and cardiac arrest was greatly reduced.