title: Fluid shift is moderate and short-lived during acute crystalloid hemodilution and normothermic cardiopulmonary bypass in piglets.
abstract: BACKGROUND
  Crystalloids are commonly used as priming solutions during cardiopulmonary bypass (CPB). Consequently, hemodilution is a regular occurrence at the start of a CPB. This study describes the time-course variations of hemodynamic parameters, plasma volume (PV) and fluid exchange following crystalloid hemodilution at start of normothermic CPB.
  
  
  METHODS
  Forty-five anesthetized piglets were given 60-min normothermic CPB. Ringer's solution was used as priming solution and maintenance fluid. Fluid input/losses, PV, colloid osmotic pressures (plasma/interstitium), hematocrit, and s-proteins were measured, and fluid extravasation rates (FER) and intravascular protein-masses calculated.
  
  
  RESULTS
  Start of CPB resulted in a 25-30% hemodilution. To keep the fluid level of the CPB-reservoir constant after start of bypass, fluid addition [2.08 +/- 0.36 (mean +/- SEM) ml kg(-1) min(-1)] was necessary during the first 5 min. Thereafter the fluid needs to be leveled off [0.17 +/- 0.03 ml kg(-1) min(-1) (10-60 min), P < 0.001]. Fluid extravasation rate increased immediately following hemodilution from a baseline value of 0.08 +/- 0.01 to 1.75 +/- 0.34 ml kg(-1) min(-1) with a delayed decrease compared to fluid additions, to reach a 'steady-state' level of 0.22 +/- 0.03 ml kg(-1) min(-1) after 30 min (P < 0.001). Differences in time-course variations between fluid added and fluid extravasated were accompanied by changes in PV and mean arterial pressure. The colloid osmotic gradient decreased about 50% throughout the study and could partly explain the increased FER.
  
  
  CONCLUSIONS
  Acute crystalloid hemodilution contributes to fluid overload during normothermic CPB. The resulting increase in fluid extravasation is, however, moderate, short-lived and levels off to baseline values within 30 min.
authors.affiliation: Department of Anesthesia and Intensive Care, Institute for Surgical Sciences, Haukeland University Hospital, Bergen, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Farstad
authors.forename: O
authors.initials: O
authors.lastname: Haugen
authors.forename: S E
authors.initials: SE
authors.lastname: Rynning
authors.forename: H
authors.initials: H
authors.lastname: Onarheim
authors.forename: P
authors.initials: P
authors.lastname: Husby
mesh_terms: D000818:Animals; D002315:Cardiopulmonary Bypass; D000077324:Crystalloid Solutions; D005260:Female; D006438:Hemodilution; D007552:Isotonic Solutions; D008297:Male; D010952:Plasma Substitutes / Q000494:pharmacology*; D010953:Plasma Volume; D013552:Swine; D014882:Water-Electrolyte Balance / Q000502:physiology*
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes