PMID: 6370618May 1, 1984Paper

Military antishock trouser (MAST). Application as a reversible fluid challenge in patients on high PEEP

Chest
M S Jastremski, K M Beney

Abstract

Fluid management in the critically ill patient receiving high levels of positive end-expiratory pressure (PEEP) can be difficult. PEEP may cause the cardiac index to fall due to a decrease in left ventricular preload. However, the high intrathoracic pressures produced by PEEP negate the usefulness of the pulmonary artery occlusion pressure (PAo) as a measurement of left ventricular preload. The military antishock trouser (MAST), which has been presumed to compress the venous capacitance reservoir and auto-transfuse 500 to 1,000 ml to the central circulation, was used as a reversible predictor of the effects of fluids on 12 critically ill patients receiving PEEP greater than 10 cm H2O with a decreased cardiac index. Hemodynamic variables were measured before, during, and after MAST inflation. Fluids were given in a quantity sufficient to maintain the same PAo after MAST deflation as achieved with the initial inflation. A significant improvement of cardiac performance and a high correlation between MAST and post-MAST variables was observed. Application of MAST as a reversible fluid challenge is a useful method for predicting optimal fluid management.

References

Sep 1, 1977·The Journal of Trauma·N E McSwain
Nov 25, 1982·The New England Journal of Medicine·I M WeismanR M Rogers
Feb 1, 1980·Critical Care Medicine·M Walkinshaw, W C Shoemaker
Feb 12, 1981·The New England Journal of Medicine·F JardinJ P Bourdarias
Nov 1, 1981·The Journal of Trauma·F A GaffneyC G Blomqvist
Jan 1, 1981·The Journal of Trauma·B A PalafoxA B Gazzaniga

Citations

May 1, 1988·Annals of Emergency Medicine·N E McSwain

Related Concepts

Care of Intensive Care Unit Patient
Oxiken
Intropin
Rehydration
Anti-Shock Trousers
Heart
Hemodynamics
Positive End-Expiratory Pressure
Respiratory Distress Syndrome, Adult

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