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Evaluation of the biologic importance of various hemodynamic and oxygen transport variables
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1979
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Trauma ResuscitationHemodynamicsPrognosisGas Exchange ProcessPrehospital ResuscitationLogistic AnalysisOxidative StressBlood FlowCritical Care MedicineHematologyOxygen Transport VariablesBiologic ImportanceBest PredictorsHealth SciencesPulmonary CirculationHypoxia (Medicine)Perioperative MonitoringVascular BiologyPerioperative CareCritical Care ManagementPrognostic EvaluationPhysiologyPatient SafetyTissue OxygenationMetabolismMedicineCritical Emergency MedicineRed Cell FlowAnesthesiology
The study aims to identify which monitored hemodynamic and oxygen transport variables most effectively predict survival versus death to guide clinical decision‑making. Using data from 113 critically ill postoperative patients, the authors calculated predictive coefficients for each monitored variable at each shock stage, treating the coefficient as a measure of clinical usefulness. Predictive accuracy ranged from 91 % to 60 %, with vital signs performing poorly, while perfusion‑related variables were the best predictors, followed by blood flow, volume, oxygen transport, and stress‑related measures.
In a series of 113 consecutively monitored, critically ill postoperative patients, predictive coefficients for each monitored hemodynamic and oxygen transport variable (parameter) were determined based on their ability to predict outcome at each stage of postoperative shock. As this predictive coefficient reflected the probability of death or survival, it was used as a criterion of the variable's clinical usefulness. The range of correct predictions by the 35 variables varied from 91–60%, but there were marked variations in their capability to predict outcome during each successive stage of postoperative shock. The commonly monitored variables, i.e., vital signs, HR, temp, central venous pressure (CVP), and Hgb, were the poorest predictors. Perfusion-related variables, which express the interrelationships of O2 transport to red cell volume and red cell flow, were among the best predictors. Blood flow, blood volume, O2 transport, and stressrelated variables were the next in order as judged by survival statistics. As the relevance of a given variable to survival or death is a criterion of its usefulness to clinical decision-making, it is appropriate to select those monitored variables that provide the desired information.