the no vasopressors in hypovolemic pts dogma challenge ?

[IVAN HRONEK]

Absolutely, crystalloids in TBI will make things worse. That's why there is a lot of interest in using vasopressin alongside fluids, apart from hypertonic saline.
 
Some papers show worsened acidosis, cardiac output and mixed venous oxygen saturation with that approach,
other show improvement, especially when used together with fluids.
 
But if we want to decrease the amount of crystalloid we need to go the pressor way.
 
We're specifically interested in doing research in this area, perhaps starting with case studies using pressors,
and the TBI pts.  might be the best to start with due to what K is saying in his email: 
 
this of course contradicts the "no vasopressors in hypovolemic patient " dogma.
 
Would love to hear people's views on that ! 
I



> From: KMATTOX at aol.com> Date: Sun, 5 Aug 2007 17:36:03 -0400> To: trauma-list at trauma.org> Subject: Re: Importance of keeping CPP > 60 mm Hg in TBI> > > In a message dated 8/5/2007 4:30:51 P.M. Central Daylight Time, ih7 at msn.com > writes:> > if the ICP is increased, you need to keep the MAP 60 mm higher so the blood > flows forward through the brain> > > I would agree with that, but would plead that it is NOT crystalloid fluids > which should be used to achieve that MAP. Remember that most of the studies > of the past 30-40 yrs were in patients that had 3 liters (or more) challenge > of crystalloid prior to any surgeon, especially neurosurgeon, seeing them. > The ICP increase is a complex compartment syndrome and much of our > traditional urban legend therapy actually iatrogenicly contributed to the spiraling > increase in ICP. > > I am delighted to see the direction of the discussions on this web site, and > do believe that it is going to lead to a whole new wave of research. > > k> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/