[Extravascular lung water in patients after cardiac surgery].
Extravascular lung water (EVLW) measured by a double indicator dilution method using thermal-dye indicator was evaluated in 204 patients after cardiac surgery during last 7 years. The measurement of EVLW was done at 2, 4, 8, 24 and 48 hours after extracorporeal circulation (ECC), EVLW showed no significant change except transient decrease at 4 hours after ECC, average of that was 7.62 +/- 3.58 ml/kg, EVLW of group I (MVR) and group III (AVR + MVR) were significantly higher than those of group II (AVR), group IV (noncyanotic congenital heart disease) and group V (A-C bypass). EVLW of 7 patients with postoperative pulmonary edema was 14.47 +/- 4.44 ml/kg, and that was significantly higher than those of others (7.54 +/- 3.06 ml/kg). EVLW of the patients using bubble oxygenator (8.60 +/- 3.90 ml/kg) was significantly higher than those of membrane oxygenator (7.15 +/- 3.40 ml/kg). Postoperative EVLW correlated with mean pulmonary artery pressure (mPAP), mean left atrial pressure (LAP) and microvascular hydrostatic pressure (PMV), and showed inverse correlation with cardiac index (CI). But there was no correlation of EVLW with duration of ECC. In the preoperative parameter, EVLW correlated with age, mPAP, mean pulmonary wedge pressure (mPAWP), PMV, serum BUN and serum creatinine, and showed inverse correlation with CI, %VC, FEV%, PSP test and creatinine clearance. We concluded that the patients with mitral valve disease who have high mPAP and LAP, respiratory and renal dysfunction and old aged preoperatively showed upward trend of EVLW. In perioperative management, care must be taken in such patients and membrane oxygenator was thought useful for prevention of pulmonary edema.(ABSTRACT TRUNCATED AT 250 WORDS)
Iha
K
K
Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Koja
K
K
Kuniyoshi
Y
Y
Akasaki
M
M
Miyagi
K
K
Shinya
E
E
Ohmine
Y
Y
Shiroma
H
H
Kina
M
M
Kusaba
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D002648:Child; D015633:Extravascular Lung Water / Q000378:metabolism*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D007201:Indicator Dilution Techniques; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011654:Pulmonary Edema / Q000175:diagnosis / Q000517:prevention & control*