Clinical Chemistry
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Clinical Chemistry 36: 1536-1543, 1990;
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shoemaker, W. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Shoemaker, W. C.

Clinical Chemistry, Vol 36, 1536-1543, Copyright © 1990 by American Association for Clinical Chemistry

What should be monitored? The past, present, and future of physiological monitoring

WC Shoemaker
Department of Surgery, King-Drew Medical Center, Los Angeles, CA.

The status of conventional monitoring by vital signs and present concepts of invasive monitoring with the balloon-tipped pulmonary artery (Swan-Ganz) catheter are reviewed. Survivors of high-risk general surgery were observed to have cardiac index (CI) values averaging 4.5 L/min.m2, oxygen delivery (DO2) greater than 600 mL/min.m2, and oxygen consumption (VO2) greater than 170 mL/min.m2. By contrast, those who subsequently died during their hospitalization maintained relatively normal CI, DO2, and VO2 values. However, in the immediate postoperative period, values for other hemodynamic variables were not greatly different for survivors and nonsurvivors or different from the normal range. A predictive index based on these observations predicted outcome correctly in 94% of the subjects in a subsequent prospective study. The use of survivor values as appropriate therapeutic goals was tested in prospective randomized clinical trials and was found to reduce mortality and morbidity significantly. Simultaneous invasive and noninvasive hemodynamic and oxygen-transport monitoring systems were evaluated in high-risk postoperative patients to describe unanticipated adverse circulatory events. Before the monitored event, about three-fourths of the patients exhibited normal function. At the nadir, cardiac functions decreased in about two- thirds, perfusion decreased in more than one-half, and paO2 fell in only one-fourth. Two-thirds recovered with increased cardiac function, more than one-half had improved perfusion, and paO2 increased in fewer than one-fifth of monitored events. These data provide an information base for criteria needed to develop therapeutic decision rules for noninvasive monitoring systems. When noninvasive data are continuously displayed early in the course of critical illness and high-risk conditions, therapy may be instituted early, while physiological deficits are still minimal and easily reversible.


The following articles in journals at HighWire Press have cited this article:


Home page
 BMJHome page
N. Soni
Swan song for the Swan-Ganz catheter?
BMJ, September 28, 1996; 313(7060): 763 - 764.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1990 by the American Association for Clinical Chemistry.