August 1974

Postresuscitation Hypertension

Arch Surg. 1974;109(2):334. doi:10.1001/archsurg.1974.01360020194039

Reply  To the Editor.—Postresuscitation hypertension, a syndrome of hypertension, severe respiratory failure, hematuria, and central nervous system irritability, is due to the rapid autoinfusion of fluids previously sequestered in an obligatory third space. This acute hypervolemic state occurs 36 to 72 hours after resuscitation and must not be confused with overinfusion of saline initially. We concur with the need to replace whole blood; our patients received an average of 18 transfusions during the preand intraoperative period (phase 1). Additional saline is administered by ourselves and by Carey and co-workers to maintain blood pressure, pulse, and urine output, not to test patient tolerance. Fluid restriction leads to continued hypotension, renal shutdown, and death.Shires and co-workers, using different methodology, have reconfirmed a reduction in extracellular fluid (ECF) during shock; this is best corrected with blood and saline infusion.1 Although Dr. Bredenberg found "an insignificant ECF deficit" in seven patients

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