Abstract
Goals of resuscitation in the emergency department for patients with confirmed or suspected acute mesenteric ischemia (AMI) are to preserve perfusion, minimize ischemic tissue, and prevent development of sepsis or multiorgan failure. Because the downstream effects of ischemia include decreased oxygen delivery to hypo-perfused tissues resulting in lactate accumulation and acidemia, fluid resuscitation with crystalloid fluids should be initiated as soon as AMI is suspected. There is no benefit to resuscitation with colloid fluids over crystalloid fluids. Vasopressors should be used with caution, but if indicated, norepinephrine alone or in combination with dobutamine is recommended. Antibiotic coverage should be initiated early and cover both Gram-negative and anaerobic bacteria.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Vitin AA, Metzner JI. Anesthetic management of acute mesenteric ischemia in elderly patients. Anesthesiol Clin. 2009;27(3):551–67.
Kolkman J, Geelkerken R. Chapter 162: splanchnic ischemia. In: Textbook of critical care, vol. e2. New York: Elsevier; 2017. p. 1135–42.
Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2013;2:CD000567. https://doi.org/10.1002/14651858.CD000567.pub6.
Jamieson W, Pliagus G, Marchuk S, et al. Effect of antibiotic and fluid resuscitation upon survival times in experimental intestinal ischemia. Surg Gynecol Obstet. 1988;167(2):103–8.
Lisbon A. Dopexamine, dobutamine, and dopamine increase splanchnic blood flow: what is the evidence? Chest. 2003;123(Suppl 5):460S–3S.
Bomberg H, Groesdonk HV, Raffel M, et al. Vasopressin as therapy during nonocclusive mesenteric ischemia. Ann Thorac Surg. 2016;102(3):813–9.
Bala M, Kashuk J, Moore EE, et al. Acute mesenteric ischemia: Guidelines of the world society of emergency surgery. World J Emerg Surg. 2017;12:38. –017–0150-5. eCollection 2017.
Plonka AJ, Schentag JJ, Messinger S, Adelman MH, Francis KL, Williams JS. Effects of enteral and intravenous antimicrobial treatment on survival following intestinal ischemia in rats. J Surg Res. 1989;46(3):216–20.
Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016;42(2):253–70.
Schoots I, Levi M, Reekers J, Lameris J, van Gulik T. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol. 2005;16(3):317–29.
Ieradi A, Tsetis D, Angileri S, et al. The role of endovascular therapy in acute mesenteric ischemia. Ann Gastroenterol. 2017;20(5):526–33.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ronan-Bentle, S. (2019). What Are the Goals of Resuscitation in the ED? What Intravenous Fluids Should Be Used? Are Vasopressors Beneficial or Harmful? Should Antibiotics Be Administered?. In: Graham, A., Carlberg, D.J. (eds) Gastrointestinal Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-98343-1_32
Download citation
DOI: https://doi.org/10.1007/978-3-319-98343-1_32
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-98342-4
Online ISBN: 978-3-319-98343-1
eBook Packages: MedicineMedicine (R0)