Hemodinamia del niño quemado grave / Hemodynamic of critically y burned children

Se describe la experiencia del Servicio de Terapia Intensiva del Hospital de Niños J.M de los Ríos en niños quemados graves a quien se les practicó cateterización de la arteria pulmonar y determinación del gasto cardíaco por termodilución. Se analizaron los cambios hemodinámicos por la quemadura, así como por la terapia administrada. La presión en cuña pulmonar se apreció que no guarda correlación con la presión venosa central en estos pacientes, siendo la medición de la primera un indicador más confiable de los cambios circulatorios. Una depresión de la función miocárdica fue vista en la evolución de estos casos. Inotrópicos; dopamina sola o asociada a digitálicos o a dobutamina, así como isoproterenol fueron utilizados para incrementar el trabajo miocárdico izquierdo. Se enfatiza que para el manejo racional del niño quemado grave es necesario un monitoreo completo de sus variables hemodinámicas

Acute haemodynamic effects following acute cardiac tamponade in dogs

This study was carried out on 20 male dogs in which increasing volumes of saline were injected intrapericardially. Electrocardiography [ECG], heart rate, mean aortic pressure, right atrial pressure, mean right ventricular pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure [PCWP], pulmonary vascular resistance [PVR] and cardiac output [CO] were measured before and after injection of 50, 100 and 200 ml of saline into the pericardial sac, then 15 minutes after evacuation of the pericardium. Heart rate showed significant decrease after injection of 100, 150 and 200 ml saline into the pericardial sac. At 15 minutes after saline evacuation, heart rate started to increase, but still below the control values. Mean aortic blood pressure showed a significant decrease after injection of 100, 150 and 200 ml saline into pericardial sac and started to increase at 15 minutes after saline evacuation. Right atrial pressure and mean right ventricular pressure showed significant increase after injection of 150 and 200 ml saline; mean pulmonary artery and pulmonary capillary wedge pressure were significantly increased after injection of increasing volumes of saline. At 15 minutes after evacuating the right atrial pressure, the pulmonary artery pressure, the pulmonary capillary wedge pressure started to decrease, but still significantly higher than normal; while the mean right ventricular pressure showed insignificant change as compared with normal. Cardiac output and pulmonary vascular resistance showed significant decrease after injection of increasing volumes of saline. At 15 minutes after saline evacuation, both values showed insignificant change from the normal value. As regards the electrocardiographic feature of cardiac tamponade, inversion of T wave appeared after infusion of 50 ml of saline into the pericardial sac and continued after infusion of 100, 150 and 200 ml of saline, and it became normal after saline evacuation. ST segment showed either elevation or depression after saline injection and it became isoelectric after saline evacuation