Fluid challenge in patients at risk for fluid loading-induced pulmonary edema.
BACKGROUND
This study evaluated the effects of protocol-guided fluid loading on extravascular lung water (EVLW) and hemodynamics in a group of patients at high risk for volume expansion-induced pulmonary and systemic edema.


METHODS
Nine acutely admitted septic patients with acute lung injury (ALI) were prospectively studied. In addition to sepsis and ALI, the following criteria indicating increased risk for edema formation had to be fulfilled: increased vascular permeability defined as microalbuminuria greater than fivefold normal and hypoalbuminemia < 30 g l(-1). Two hundred-ml boluses of a 10% hydroxyethyl starch (HES) was titrated to obtain best filling pressure/stroke volume relation. Extravascular lung water and intrathoracic blood volume (ITBV) were measured using a transpulmonary double-indicator dilution technique. Baseline data were compared with data at the end of fluid loading and 3 h postchallenge.


RESULTS
At study entry the mean EVLW was 13 ml kg(-1), and the mean EVLW/ITBV ratio (indicator of pulmonary permeability) was 0.72 (normal range 0.20-0.30). To attain optimal preload/stroke volume relation 633 +/- 240 ml of HES was needed. Fluid loading significantly increased preload (CVP, PAOP and ITBV), and stroke volume. Effective pulmonary capillary pressure (Pcap) rose only slightly. As a result, the Pcap-PAOP gradient decreased. Despite increased cardiac output, EVLW did not change by plasma expansion.


CONCLUSIONS
In this selected group of at-risk patients, the optimization of cardiac output guided by the concept of best individual filling pressure/stroke volume relationship did not worsen permeability pulmonary edema.
Matejovic
M
M
ICU, 1st Medical Department, Charles University Hospital Plzen, Alej svobody 80, 304 60 Plzen, Czech Republic. matejovic@fnplzen.cz
Krouzecky
A
A
Rokyta
R
R
Novak
I
I
D018806:APACHE; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015633:Extravascular Lung Water / Q000502:physiology; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives; D008171:Lung Diseases / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes; D011654:Pulmonary Edema / Q000209:etiology* / Q000517:prevention & control*; D018805:Sepsis / Q000628:therapy; D013318:Stroke Volume / Q000502:physiology
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes