END POINTS IN RESUSCITA TION OF SHOCK: UNDERST ANDING THE EVOLUTION

D S Timilsina,P C Majhi,S N Bawa

doi:10.31729/jnma.594

Abstract

In the last two decades resuscitation strategies have gone through revolutionary changes. Ideas once heldsacred have been questioned and the very foundations on which these strategies were based shaken.Resuscitation strategies basically revolve around three questions:1. How much?2. How fast?3. When to stop?Evolutions of shocked patient management concepts show three distinct phases.• Phase 1 – Clinical parameter based.• Phase 2 – Oxygen variables based.• Phase 3 – Cellular perfusion based.Accepted criteria for endpoints of resuscitation too have undergone similar changes in paradigm and canbe grouped under similar phases.Key Words: Shock, Clinical parameter, cellular perfusion, resuscitation.

Highlights

Most of the primary descriptive features of the shocked state are clinical in nature
The first real challenge to the adequacy of clinical signs as end point of resuscitation was the landmark paper by Shires and Canizaro 2 who demonstrated a 20% mortality rate over long term in animals successfully resuscitated using fluid volumes based on direct measurements of intra and extra vascular fluid deficits
Shoemaker[13] reported in 1988 that MAP and cardiac output (CO) decreased while patients were in shock and increased immediately upon resuscitation

Summary

INTRODUCTION

Most of the primary descriptive features of the shocked state are clinical in nature. They included bedside patient observations vital signs and urine output etc. In any group of patients presenting with severe shock approximately 12% - 18% mortality or significant morbidity will occur.[1] The first real challenge to the adequacy of clinical signs as end point of resuscitation was the landmark paper by Shires and Canizaro 2 who demonstrated a 20% mortality rate over long term in animals successfully resuscitated using fluid volumes based on direct measurements of intra and extra vascular fluid deficits.

MATERIALS AND METHODS

Findings

CONCLUSION