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Physiologic State, Metabolic Adequacy, and the Sequence of Development of the Physiologic Determinants of Survival

John H. Siegel, MD; Ivo Giovannini, MD; Bill Coleman; Frank B. Cerra, MD; Angelo Nespoli, MD

Arch Surg. 1981;116(10):1330-1341.

Abstract
• Detailed serial cardiovascular and respiratory physiologic studies were carried out in 80 patients with cirrhotic liver disease, including 45 cirrhotic patients who underwent portal decompressive surgery on an urgent or elective basis. In surgical cases, death could be predicted from the first postoperative day's pattern of response. Predictors of death were an increase in percent of pulmonary shunt due to a redistribution of the increased pulmonary blood flow, and a disproportionate fall in vascular tone, which permits an increased cardiac ejection fraction even when significant myocardial depression occurs. The etiology of the vascular tone defect seems related to the rise in levels of the false neurotransmitter octopamine, which are shown to increase as oxygen consumption falls in the pathophysiologic hyperdynamic B state, presumably due to a block in the oxidative metabolism of aromatic amino acids.

(Arch Surg 1981;116:1330-1341)

Author Affiliations
From the Department of Surgery, State University of New York at Buffalo and The Buffalo General Hospital (Drs Siegel and Cerra, and Mr Coleman), the Universita Cattolica del Sacro Cuore Polyclinico Gemelli, Rome (Dr Giovannini), and the Universita degli Studi di Milano Ospedale Policlinico, Milan, Italy (Dr Nespoli).

Footnotes
Accepted for publication June 5, 1981.

Reprint requests to the State University of New York at Buffalo, Department of Surgery, The Buffalo General Hospital, 100 High St, Buffalo, NY 14203 (Dr Siegel).

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