CHRONIC SHOCK

Abstract

I. Wt. loss, decreased blood vol., decreased blood proteins and increased interstitial fluid vol. were correlated as the surgically significant features of protein depletion of the body in a syndrome of chronic shock. Body protein was presented as a factor in the dynamic equilibrium of fluid exchange across the capillary wall. The necessity for adoption of some modification of current concepts was indicated. II. Reduction in blood vol. was part of the surgically significant pattern of protein depletion. Blood vol. deficits in depleted patients should be calculated on the basis of standard for usual wt. prior to illness. Correction of Hb or red cell deficits by repeated blood transfusion restored the vol. to the standard value without producing clinically significant hemoconc. During convalescence associated with recovery from disease there was evidence of maintained re-establishment of the blood vol. In the absence of continued bleeding, blood volume replacement by transfusion therapy was quantitative. Quantitative correction of blood vol. deficits by whole blood transfusions increased the tolerance of the "poor risk" patients for major surgical procedures. III. Blood vol. studies in 38 patients with malignant disease were presented. The major factor responsible for the reduced blood vol. associated with malignant disease was a deficiency of total circulating cell mass and Hb. In malignant disease, there was a fundamental disturbance in Hb metabolism. Adequate pre-operative prepn. of patients with malignant disease was accomplished only by transfusion replacement therapy.