Studies in Clinical Shock and Hypotension

Abstract

Thirty-one patients with nonhemorrhagic shock or hypotension of diverse etiologies accompanied by low cardiac output and normal or low right atrial pressure were given a rapid infusion of dextran. Cardiac output returned to normal in 20 patients and shock or hypotension was corrected in 16. In 10 patients with evidence of vasoconstriction and normal cardiac function, dextran reversed the circulatory abnormality, returning blood pressure, cardiac output, and peripheral vascular resistance to normal. Twelve patients with hypotension without evidence of reflex vasoconstriction were improved by dextran but the hypotension persisted occasionally. In nine patients, dextran revealed heart failure as manifested by a precipitous rise in right atrial pressure without much increase in cardiac output. Control hemodynamic observations and the response to dextran could not necessarily be predicted from the nature of the disease which precipitated the shock. The efficacy of a rapid infusion of low molecular weight or clinical dextran associated with its freedom from significant toxicity should make it the treatment of choice in non-hemorrhagic shock of any cause associated with normal central venous pressure.