RESUSCITATION OF THE CRITICALLY ILL IN THE ED - RESPONSES OF BLOOD-PRESSURE, HEART-RATE, SHOCK INDEX, CENTRAL VENOUS OXYGEN-SATURATION, ANDLACTATE

To describe the simultaneous responses of systolic blood pressure (SEP ), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR), shock index (SI = HR/SBP), central venous oxyhemoglo bin saturation (ScvO(2)), and arterial blood lactate concentration (La ct) to resuscitation of critically ill patients in the emergency depar tment (ED), an observational descriptive study was conducted in the ED of an urban teaching hospital. Thirty-six patients admitted from the ED to the medical intensive care unit were studied. Vital signs were m easured immediately an arrival to the ED (phase 1). After initial resu scitation and stabilization, ie, HR between 50 and 120 beats/min and M AP between 70 and 110 mm Hg (phase 2), ScvO(2) and Lact were measured and additional therapy was given in the ED to increase ScvO? to >65% a nd decrease Lact to <2 mmol/L, if needed (phase 3). SEP, DBP, MAP, Ha, SI, ScvO(2), and Lact were measured. Initial resuscitation increased SEP from 103 +/- 39 to 118 +/- 29 mm Hg (P < .05) and MAP from 67 +/- 35 to 82 +/- 22 mm Hg (P < .05) but did not affect DBP (53 +/- 35 to 6 3 +/- 22 mm Hg, P = NS), Ha (110 +/- 26 to 110 +/- 22 beats/min, P = N S) or Si (from 1.3 +/- 0.7 to 1.0 +/- 0.3, P = NS) from phase 1 to pha se 2. ScvO(2) remained <65% and/or Lact >2.0 mmol/L in 31 of 36 patien ts at phase 2, and additional therapy was required, Lact was decreased (from 4.6 +/- 3.8 to 2.6 +/- 2.5 mmol/L, P < .05) and ScvO(2) was inc reased (from 52 +/- 18 to 65 +/- 13%, P < .05) without significant add itional changes in SEP, DBP, MAP, HR, or SI at phase 3. The in-hospita l mortality was 14% for this group of patients. It was concluded that additional therapy is required in the majority of critically ill patie nts to restore adequate systemic oxygenation after initial resuscitati on and hemodynamic stabilization in the ED. Additional therapy to incr ease ScvO(2) and decrease Lact may not produce substantial responses i n SEP, DBP, MAP, HR, and SI. The measurement of ScvO(2) and Lact can b e utilized to guide this phase of additional therapy in the ED. (Copyr ight (C) 1996 by W.B. Saunders Company)