This document discusses traditional and new endpoints for resuscitation. Traditionally, patients were resuscitated until they had normal vital signs like pulse and blood pressure. However, these parameters only monitor major organs and do not indicate global perfusion. Patients can have normal vitals but still have "occult hypoperfusion" of other organs for over 12 hours, increasing mortality risk. New algorithms use lactate, base deficit, and mixed venous oxygen saturation to assess global perfusion. Maintaining lactate below 2 mmol/L and base deficit between -2 to +2 through resuscitation improves outcomes for high-risk surgery patients.

1. End Points Of Resuscitation
Dr. Ali Raza
Post-Graduate Resident
East Surgical Ward
KEMU/Mayo Hospital Lahore

2. Traditional End Points Of Resuscitation
• Traditionally, patients have been resuscitated until they have a normal pulse,
blood pressure and urine output.
• However, these parameters are monitoring organ systems whose blood flow is
preserved until the late stages of shock.
• A patient therefore may be resuscitated to restore central perfusion to the
brain, lungs and kidneys and yet continue to under perfuse the gut and muscle
beds. Thus, activation of inflammation and coagulation may be ongoing and
lead to reperfusion injury when these organs are finally perfused, and
ultimately multiple organ failure.

3. ‘Occult Hypoperfusion’.
State of normal vital signs and continued underperfusion is termed
‘occult hypoperfusion’. Occult hypoperfusion for >12 hours increase
mortality two to three times.
Resuscitation algorithms directed at correcting global
perfusion end points (base deficit, lactate, mixed venous oxygen
saturation) rather than traditional end points have been shown to
improve mortality and morbidity in high-risk surgical patients

5. BASE DEFICIT AND LACTATE
• These parameters are measured from arterial blood gas analyses ,the base deficit
and/or lactate should be measured routinely in the patients until they have
returned to normal levels.
• lactate is an essential marker of resuscitation
• <2 mmol/L – Early total care
• 2–3 mmol/L – Look at the trend (increasing or decreasing)
• >3 mmol/L – May be under-resuscitated; should either have further resuscitation
or damage control surgery (DCS) if surgery is urgent
• >5 mmol/L – DCS,
• Base Deficit: -2 to +2

7. MIXEDVENOUS OXYGEN SATURATION
The percentage saturation of oxygen returning to the heart from the body is a
measure of the oxygen delivery and extraction by the tissues.
• Accurate measurement ‣R atrium
• Rough Estimations ‣SVC blood, but these values will be slightly higher than
those of a mixed venous sample (as there is relatively more oxygen extraction
from the lower half of the body).
• Normal mixed venous oxygen saturation levels are 50–70%.
• If<50%
• If>70%

8. Thank you