Document Detail


Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery.
MedLine Citation:
PMID:  16311279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The optimal type of fluid for treating hypovolaemia without evoking pulmonary oedema is still unclear, particularly in the presence of pulmonary vascular injury, as may occur after cardiac and major vascular surgery. METHODS: In a single-centre, prospective, single-blinded clinical trial 67 mechanically ventilated patients were randomly assigned to receive saline, gelatin 4%, HES 6% or albumin 5%, according to a 90 min fluid loading protocol with target central venous pressure of 13 and pulmonary capillary wedge pressure of 15 mm Hg, within 3 h after cardiac or major vascular surgery. Before and after the protocol, we recorded haemodynamics and ventilatory variables and took chest radiographs. The pulmonary vascular injury was evaluated using the 67Ga-transferrin pulmonary leak index (PLI) and extravascular lung water (EVLW). Plasma colloid osmotic pressure (COP) was determined and the lung injury score (LIS) was calculated. RESULTS: More saline was infused than colloid solutions (P<0.005). The COP increased in the colloid groups and decreased in patients receiving saline. Cardiac output increased more in the colloid groups. At baseline, PLI and EVLW were above normal in 60 and 30% of the patients, with no changes after fluid loading, except for a greater PLI decrease in HES than in gelatin-loaded patients. The oxygenation ratio improved in all groups. In the colloid groups, the LIS increased, because of a decrease in total respiratory compliance, probably associated with an increase in intrathoracic plasma volume. CONCLUSIONS: Provided that fluid overloading is prevented, the type of fluid used for volume loading does not affect pulmonary permeability and oedema, in patients with acute lung injury after cardiac or major vascular surgery, except for HES that may ameliorate increased permeability. During fluid loading, changes in LIS (and respiratory compliance) do not represent changes in pulmonary permeability or oedema.
Authors:
J Verheij; A van Lingen; P G H M Raijmakers; E R Rijnsburger; D P Veerman; W Wisselink; A R J Girbes; A B J Groeneveld
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2005-11-25
Journal Detail:
Title:  British journal of anaesthesia     Volume:  96     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-16     Completed Date:  2006-01-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  21-30     Citation Subset:  IM    
Affiliation:
Department of Intensive Care, Institute for Cardiovascular Research, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiac Output
Cardiovascular Surgical Procedures*
Colloids / adverse effects,  therapeutic use
Extravascular Lung Water
Female
Fluid Therapy / adverse effects,  methods*
Humans
Male
Middle Aged
Osmotic Pressure
Permeability
Plasma Substitutes / adverse effects*,  therapeutic use
Postoperative Care / methods
Prospective Studies
Pulmonary Edema / etiology*
Respiratory Distress Syndrome, Adult / etiology*
Single-Blind Method
Sodium Chloride / adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Colloids; 0/Plasma Substitutes; 7647-14-5/Sodium Chloride

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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