Resuscitation from shock

A method for resuscitating a victim of shock, comprising:

• identifying a risk of major organ failure;
• determining indices of peripheral perfusion deficit of the victim;
• determining an oxygen delivery index of the victim;
• comparing the oxygen delivery index of the victim to an oxygen delivery index goal;
• if the oxygen delivery index of the victim is greater than or equal to the oxygen delivery index goal:
• comparing the indices of peripheral perfusion deficit with peripheral perfusion deficit thresholds;
• and
• ending resuscitation if the indices of peripheral perfusion deficit meet the peripheral perfusion deficit thresholds;
• and
• if the oxygen delivery index of the victim is less than the oxygen delivery index goal:
• comparing hemoglobin concentration of the victim with a hemoglobin concentration threshold;
• transfusing one or more units of packed red blood cells if the hemoglobin concentration of the victim is less than the hemoglobin concentration threshold;
• comparing pulmonary artery wedge pressure of the victim with a pulmonary artery wedge pressure threshold;
• administering a volume loading protocol if the pulmonary artery wedge pressure of the victim is less than the pulmonary artery wedge pressure threshold;
• monitoring responses of the pulmonary artery wedge pressure and cardiac index of the victim to determine if the pulmonary artery wedge pressure and cardiac index are optimized;
• and
• administering a Starling Challenge if the pulmonary artery wedge pressure and cardiac index are not optimized.

A method for implementing a volume loading protocol for resuscitating a victim of shock, the method comprising:

• administering a first volume of Ringer's lactate bolus to the victim;
• determining a change in pulmonary artery wedge pressure of the victim in response to the administering of the first volume;
• administering a second volume of Ringer's lactate bolus to the victim if the change in pulmonary artery wedge pressure is less than a first specified increment;
• measuring the pulmonary artery wedge pressure of the victim;
• administering a third volume of Ringer's lactate bolus to the victim if the pulmonary artery wedge pressure of the victim is less than a second threshold.

A method for implementing a Starling Challenge for resuscitating a victim of shock due to trauma or hemorrhage, the method comprising:

• administering a first volume of solution to the victim;
• determining a change in pulmonary artery wedge pressure of the victim in response to the administering of the first volume;
• administering a second volume of the solution to the victim if the change in pulmonary artery wedge pressure is less than a first specified increment;
• determining a change in cardiac index of the victim in response to the administering of the solution;
• if the change in pulmonary artery wedge pressure is greater than or equal to the first specified increment and less than or equal to a second specified increment:
• administering a third volume of the solution to the victim if the change in cardiac index is greater than or equal to a third specified increment;
• ending the protocol if the change in cardiac index remains less than the third specified increment after two consecutive administrations of a fourth volume of the solution to the victim;
• if the change in pulmonary artery wedge pressure is greater than the second specified increment:
• administering a fifth volume of the solution to the victim if the change in cardiac index is greater than or equal to a fourth specified increment;
• and
• ending the protocol if the change in cardiac index remains less than the fourth specified increment after two consecutive administrations of a sixth volume of the solution to the victim.

A method for implementing a vasopressor and inotrope therapy for resuscitating a victim of shock, the method comprising:

• if mean arterial pressure of the victim is less than an arterial pressure threshold:
• administering a vasopressor agent at a first rate;
• determining mean arterial pressure in response to the vasopressor agent;
• administering the vasopressor agent at a second rate, the second rate being greater than the first rate and less than a first maximum rate, until the mean arterial pressure meets or exceeds the arterial pressure threshold;
• if mean arterial pressure of the victim is greater than or equal to the arterial pressure threshold and an oxygen delivery index of the victim is less than an oxygen delivery index goal:
• administering an inotrope agent at a third rate;
• determining hemodynamic performance in response to the inotrope agent;
• administering the inotrope agent at a fourth rate, the fourth rate being greater than the third rate and less than a second maximum rate, until the hemodynamic performance meets a hemodynamic performance goal.