Effects of colloid or crystalloid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting.
The effect of postoperative fluid management on pulmonary extravascular thermal volume (ETVL) as in index of pulmonary extravascular water after coronary artery bypass grafting was compared, using the thermal-dye technique, among five patients who received 5% albumin (group A), five patients who received 6% hydroxyethyl starch (group H), and five who received lactated Ringer's solution (group C). Intraoperatively, all patients received lactated Ringer's solution intravenously, and the cardiopulmonary bypass (CPB) circuit prime included 5% albumin. No statistically significant changes in ETVL occurred postoperatively in any group, nor did ETVL differ significantly between groups. After CPB, colloid osmotic pressure (COP) significantly decreased and pulmonary artery wedge pressure (WP) and the WP-COP gradient significantly increased in each group, implying an increase in transcapillary fluid flux. Cardiac index changed variably. Pulmonary shunt fraction (Qsp/Qt) did not change in groups A and C but decreased during CPB in group H (from 0.22 +/- 0.03 to 0.16 +/- 0.11). Postoperatively, patients in the three groups received similar volumes of fluids and had similar perioperative weight gains. By the next morning (AM1), COP increased in all groups, returning to levels noted before CPB in group C, and exceeding these levels in groups A and H. Wedge pressure was similar in all three groups on AM1. PaO2 decreased significantly, and alveolar-arterial oxygen partial pressure difference increased significantly in all groups on AM1. In Group H, Qsp/Qt returned to levels observed before CPB by AM1 (0.27 +/- 0.09). We conclude that in patients without postoperative increases in WP, ETVL changes minimally during CPB and is not influenced by the type of fluid administered as the primary volume replacement in the postoperative period.
J D
JD
Gallagher
R A
RA
Moore
D
D
Kerns
A B
AB
Jose
S B
SB
Botros
S
S
Flicker
H
H
Naidech
D L
DL
Clark
D000368:Aged; D000418:Albumins / Q000008:administration & dosage; D001810:Blood Volume; D002315:Cardiopulmonary Bypass; D003102:Colloids; D001026:Coronary Artery Bypass; D000077324:Crystalloid Solutions; D004395:Dye Dilution Technique; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009997:Osmotic Pressure; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000503:physiopathology; D011654:Pulmonary Edema / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure; D011897:Random Allocation; D000077325:Ringer's Lactate; D013815:Thermodilution
D000418:Albumins; D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate