Applied Physiology of Fluid Resuscitation in Critical Illness

Arshed, Sabrina; Pinsky, Michael R.

doi:10.1016/j.ccc.2017.12.010

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…Initial diagnostic investigation was aimed at assessing for evidence of the major categories of vasoconstrictive shock, including hypovolemic, cardiogenic and obstructive causes. 1,12 In the assessment of shock, a useful adjunct to physical examination is point-of-care ultrasound examination using the TFAST and AFAST protocols. 13,14 Imaging of both body cavities is recommended even when abdominal lesions are detected, as illustrated by this case.…”

Section: Discussionmentioning

confidence: 99%

“…These protocols can provide evidence to support a diagnosis of hypovolemic shock (cavitary effusions, collapsibility of CVC), cardiogenic shock (reduced cardiac contractility, left atrial enlargement), or obstructive shock (cardiac tamponade from pericardial effusion, pneumothorax, right-sided cardiac pressure overload secondary to massive pulmonary thromboembolism, venous congestion). 1,12 The initial TFAST examination failed to identify the right intra-atrial mass as evaluation of the heart was hampered by severe underfilling. However, the presence of hepatic venous congestion and peritoneal modified transudate effusion in the face of severe shock raised the suspicion of an obstructive process.…”

Section: Discussionmentioning

confidence: 99%

“…bstructive shock is one of three major mechanisms of vasoconstrictive shock, resulting from impairment of ventricular filling or ejection by a physical impediment to blood flow. 1,2 Described causes in dogs include cardiac tamponade, severe pleural space disease, massive pulmonary thromboembolism and gastric dilation-volvulus. 2 However, any lesion that causes extraluminal compression or intraluminal occlusion of the cardiac chambers or major vessels could cause obstructive shock.…”

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confidence: 99%

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Obstructive shock caused by right atrial thrombosis secondary to malignant pheochromocytoma in a dog

2020

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Background Obstructive shock can be caused by any lesion leading to extraluminal compression or intraluminal occlusion of the cardiac chambers or major vessels. Case Report A 12‐year‐old, male castrated, Border Collie cross dog presented to a veterinary teaching hospital for collapse. A physical examination revealed severe vasoconstrictive shock and abdominal distension. Abnormalities on blood tests were consistent with systemic hypoperfusion. Cardiac underfilling, hepatomegaly with distended vasculature and ascites were identified by focused ultrasonography, raising suspicion of obstructive shock. This was supported by the radiographic findings of microcardia and a distended caudal vena cava (CVC). There was transient response to fluid therapy for blood volume expansion. Repeat focused ultrasonography during rapid intravenous fluid administration identified a right intra‐atrial mass, assessed as likely to be causing obstruction of venous return. The dog was humanely euthanased given the guarded prognosis. At postmortem evaluation, a malignant pheochromocytoma in the left adrenal gland with tumour thrombus extending to the tricuspid valve through the CVC was found. The extensive thrombus caused the obstructive shock in this case. Metastasis in a peripheral lymph node and neoplastic emboli in the heart and lungs were also visible at the histopathological evaluation. Conclusion To the best of authors' knowledge, this is the first report of severe obstructive shock secondary to extension of caval tumour thrombus into the right atrium in a dog with malignant pheochromocytoma. Tumour thrombus from a malignant pheochromocytoma should be included as a differential diagnosis of obstructive shock, with or without a visible right intra‐atrial mass, in dogs. Serial focused ultrasonography during intravenous fluid administration can aid diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Obstructive shock caused by right atrial thrombosis secondary to malignant pheochromocytoma in a dog

2020

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“…Hereby, the CVP is raised by performing a series of end-inspiratory hold maneuvers and CO is measured in the last three seconds of the 12 s inspiratory hold. After 7–10 s a steady state occurs when V R = CO. By plotting the CVP and CO values, a V R curve is constructed and the zero-flow pressure ( P msf) extrapolated [ 28 , 29 ].…”

Section: The Case For Mean Systemic Filling Pressurementioning

confidence: 99%

Phenylephrine-induced recruitable preload from the venous side

Jacobs¹,

Lochy²,

Malbrain

2018

J Clin Monit Comput

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“…As illustrated in Fig. 1 , the amount of unstressed volume can be rapidly and dynamically changed by changing blood flow distribution, increasing surrounding tissue pressure, or increasing venomotor tone [ 2 ]. The effective circulating blood volume reflects the proportion of blood volume above the unstressed volume and is essentially independent of arterial pressure, because arterial pressure is dissipated across the high resistance arterioles, analogous to a “vascular waterfall”.…”

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confidence: 99%