Survivor's and nonsurvivors' responses to dextran 40. Hemodynamic and oxygen transport changes in critically ill patients.

Cardiorespiratory effects of dextran 40 administration were measured and compared retrospectively in 74 surviving and 73 nonsurviving critically ill patients. In the preinfusion control period, the survivors had higher mean arterial pressures and blood flow with lesser blood volume deficits. Dextran significantly improved pressure, blood flow, blood volume, oxygen transport, and derived calculations in both groups, but the average cardiorespiratory responses to dextran were somewhat greater in nonsurvivors than in survivors, About two thirds of the patients responded to dextran with significantly increased oxygen consumption (P smaller than .05), suggesting that this agent improved oxygen transport by its rheologic effects on the microcirculation. The cardiorespiratory effects of dextran were slightly greater in the patients who ultimately died; nevertheless, the salutary cardiorespiratory response did not reverse the clinical course in nonsurvivors, whose perfusion defect apparently had reached irreversible proportions prior to the administration of the drug.