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Feng A, Lu P, Yang Y, Liu Y, Ma L, Lv J. Effect of goal-directed fluid therapy based on plasma colloid osmotic pressure on the postoperative pulmonary complications of older patients undergoing major abdominal surgery. World J Surg Oncol 2023; 21:67. [PMID: 36849953 PMCID: PMC9970856 DOI: 10.1186/s12957-023-02955-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND As an important component of accelerated rehabilitation surgery, goal-directed fluid therapy (GDT) is one of the optimized fluid therapy strategies and is closely related to perioperative complications and mortality. This article aimed to study the effect of combining plasma colloid osmotic pressure (COP) with stroke volume variation (SVV) as a target for intraoperative GDT for postoperative pulmonary complications in older patients undergoing major abdominal surgery. METHODS In this study, older patients (n = 100) undergoing radical resection of gastroenteric tumors were randomized to three groups: Group C (n1 = 31) received a conventional infusion regimen, Group S1 (n2 = 34) received GDT based on SVV, and Group S2 (n3 = 35) received GDT based on SVV and COP. The results were recorded, including the lung injury score (LIS); PaO2/FiO2 ratio; lactic acid value at the times of beginning (T0) and 1 h (T1), 2 h (T2), and 3 h (T3) after liquid infusion in the operation room; the total liquid infusion volume; infusion volumes of crystalline and colloidal liquids; urine production rate; pulmonary complications 7 days after surgery; and the severity grading of postoperative pulmonary complications. RESULTS The patients in the S2 group had fewer postoperative pulmonary complications than those in the C group (P < 0.05) and the proportion of pulmonary complications of grade 1 and higher than grade 2 in S2 group was significantly lower than that in C group (P <0.05); the patients in the S2 group had a higher PaO2/FiO2 ratio than those in the C group (P < 0.05), lower LIS than those in the S1 and C groups (P < 0.05), less total liquid infusion than those in the C group (P < 0.05), and more colloidal fluid infusion than those in the S1 and C groups (P < 0.05). CONCLUSION The findings of our study show that intraoperative GDT based on COP and SVV can reduce the incidence of pulmonary complications and conducive to shortening the hospital stay in older patients after gastrointestinal surgery. TRIAL REGISTRATION Chinese Clinical Trial. no. ChiCTR2100045671. Registry at www.chictr.org.cn on April 20, 2021.
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Affiliation(s)
- Anqi Feng
- grid.452672.00000 0004 1757 5804Department of Anesthesiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shanxi China
| | - Pan Lu
- grid.452672.00000 0004 1757 5804Department of Anesthesiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shanxi China
| | - Yanan Yang
- grid.452672.00000 0004 1757 5804Department of Anesthesiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shanxi China
| | - Ying Liu
- grid.452672.00000 0004 1757 5804Department of Anesthesiology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004 Shanxi China
| | - Lei Ma
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shanxi, China.
| | - Jianrui Lv
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shanxi, China.
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Wittkowski U, Spies C, Sander M, Erb J, Feldheiser A, von Heymann C. [Haemodynamic monitoring in the perioperative phase. Available systems, practical application and clinical data]. Anaesthesist 2009; 58:764-78, 780-6. [PMID: 19669105 DOI: 10.1007/s00101-009-1590-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A regular hydration status and compensated vascular filling are targets of perioperative fluid and volume management and, in parallel, represent precautions for sufficient stroke volume and cardiac output to maintain tissue oxygenation. The physiological and pathophysiological effects of fluid and volume replacement mainly depend on the pharmacological properties of the solutions used, the magnitude of the applied volume as well as the timing of volume replacement during surgery. In the perioperative setting surgical stress induces physiological and hormonal adaptations of the body, which in conjunction with an increased permeability of the vascular endothelial layer influence fluid and volume management. The target of haemodynamic monitoring in the operation room is to collect data on haemodynamics and global oxygen transport, which enable the anaesthetist to estimate the volume status of the vascular system. Particularly in high risk patients this may improve fluid and volume therapy with respect to maintaining cardiac output. A goal-directed volume management aiming at preventing hypovolaemia may improve the outcome after surgery. The objective of this article is to review the monitoring devices that are currently used to assess haemodynamics and filling status in the perioperative setting. Methods and principles for measuring haemodynamic variables, the measured and calculated parameters as well as clinical benefits and shortcomings of each device are described. Furthermore, the results for monitoring devices from clinical studies of goal-directed fluid and volume therapy which have been published will be discussed.
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Affiliation(s)
- U Wittkowski
- Universitätsklinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Virchow-Klinikum und Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin
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Wright BD, Hopkins A. Changes in colloid osmotic pressure as a function of anesthesia and surgery in the presence and absence of isotonic fluid administration in dogs. Vet Anaesth Analg 2008; 35:282-8. [DOI: 10.1111/j.1467-2995.2007.00388.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Adesanya A, Rosero E, Timaran C, Clagett P, Johnston WE. Intraoperative fluid restriction predicts improved outcomes in major vascular surgery. Vasc Endovascular Surg 2008; 42:531-6. [PMID: 18583299 DOI: 10.1177/1538574408318474] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Traditional fluid resuscitation during general anesthesia has been questioned in recent studies. One study of patients undergoing abdominal surgery showed decreased postoperative weight gain, earlier return of bowel function, and shorter intensive care unit (ICU) and hospital length of stay (LOS) when intraoperative crystalloid infusion was restricted. The authors conducted a retrospective study of major vascular surgery patients (neo-aorto iliac system surgery) to correlate clinical outcomes with intraoperative crystalloid fluid administration. METHODS The charts of 41 patients who underwent major vascular surgery at our institution were reviewed. Patients were grouped according to the crystalloid volume infused intraoperatively into <3 L (group 1) and >3 L (group 2). Preoperative and postoperative weights, intraoperative crystalloid administration, intraoperative vasopressor use, preoperative and postoperative creatinine, number of days to clear liquid diet, and the time to discharge from the ICU (ICU LOS) and hospital (hospital LOS) were collected. RESULTS There were statistically significant differences in duration of mechanical ventilation (0.55 +/- 0.934 vs 2.03 +/- 2.735 days, P = .013) and ICU LOS (3.0 +/- 1.48 vs 5.79 +/- 3.938, P = .029) in favor of the fluid restriction group. Major postoperative complications, such as sepsis, acute myocardial infarction, and graft thrombosis, were less frequent in the fluid restriction group but not statistically significant (5 vs 9, P = .742). Intraoperative crystalloid volume was found to be an independent predictor of ICU LOS after adjusting for estimated blood loss and duration of surgery. There was no statistically significant difference in preoperative serum albumin in both groups. CONCLUSIONS Restricted intraoperative administration of crystalloid fluids (<3 L) may be beneficial in major vascular surgery patients. These benefits are similar to those previously described in patients undergoing abdominal surgery.
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Affiliation(s)
- Adebola Adesanya
- Department of Anesthesiology, University of Texas Southwestern Medical Center at Dallas, Dallas , USA.
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Jacob M, Chappell D, Hofmann-Kiefer K, Conzen P, Peter K, Rehm M. Determinanten des insensiblen Flüssigkeitsverlustes. Anaesthesist 2007; 56:747-58, 760-4. [PMID: 17684711 DOI: 10.1007/s00101-007-1235-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Accurate perioperative fluid balance is the basis of a targeted infusion regimen. However, neither the initial status nor perioperative changes of the fluid compartments can be reliably measured in daily routine. In particular, insensible losses are not consistently assessed, so that substitution therapy is generally empirical. The object of this paper is to communicate the scientific data on this topic. Preoperative fasting (10 h) does not per se cause intravascular hypovolemia. In adults, total basal evaporation by way of the skin and airways and of any wounds during major abdominal interventions is usually less than 1 ml/kg/h. An inconstant fluid and protein shift towards the interstitial space perioperatively seems to be associated with hypervolemia, which suggests it should be preventable. The decisive factor in this context seems to be deterioration of the endothelial glycocalyx, whose further patho-physiological impact is currently only partially known. Clinical studies have revealed a link between fluid restriction and improved outcome after major abdominal surgery.
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Affiliation(s)
- M Jacob
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München Grosshadern-Innenstadt, Nussbaumstrasse 20, 80336 München.
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Abstract
The scientific knowledge base that supports clinical decisions about perioperative fluid management continues to evolve. However, despite these advancements in the understanding of the physiology of fluid replacement, the definition of ''optimal'' perioperative fluid management remains a matter of clinical judgment. With an appreciation of the many factors, both sensible and insensible, that contribute to changes in blood and extracellular fluid volume during surgery, clinicians have tried to create reproducible and generally applicable formulas for replacement of fluid during surgery. These formulas have been challenged recently by the introduction of new tools for monitoring cardiopulmonary function, by the implementation of monitor-guided protocols for fluid management, and, more recently, by clinical data suggesting that fluid restriction may improve surgical outcomes in some clinical settings. The relative ease of pre-identified fluid replacement protocols is being slowly replaced by data-guided interventions that take into account a variety of factors. Clinicians are therefore required to tailor their fluid replacement strategies based on preoperative patient characteristics, the type of surgery and even the type of anesthetic that is utilized. Some of the benefits of this new approach range from relatively ''minor'' outcomes such as diminished nausea after surgery to preventing postoperative complications such as wound breakdown and cardiopulmonary failure.
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Affiliation(s)
- Mark P Yeager
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Cotton BA, Guy JS, Morris JA, Abumrad NN. The cellular, metabolic, and systemic consequences of aggressive fluid resuscitation strategies. Shock 2006; 26:115-21. [PMID: 16878017 DOI: 10.1097/01.shk.0000209564.84822.f2] [Citation(s) in RCA: 334] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increasing evidence has demonstrated that aggressive crystalloid-based resuscitation strategies are associated with cardiac and pulmonary complications, gastrointestinal dysmotility, coagulation disturbances, and immunological and inflammatory mediator dysfunction. As large volumes of fluids are administered, imbalances in intracellular and extracellular osmolarity occur. Disturbances in cell volume disrupt numerous regulatory mechanisms responsible for keeping the inflammatory cascade under control. Several authors have demonstrated the detrimental effects of large, crystalloid-based resuscitation strategies on pulmonary complications in specific surgical populations. Additionally, fluid-restrictive strategies have been associated with a decreased frequency of and shorter time to recovery from acute respiratory distress syndrome and trends toward shorter lengths of stay and lower mortality. Early resuscitation of hemorrhagic shock with predominately saline-based regimens has been associated with cardiac dysfunction and lower cardiac output, as well as higher mortality. Numerous investigators have evaluated potential risk factors for developing abdominal compartment syndrome and have universally noted the excessive use of crystalloids as the primary determinant. Resuscitation regimens that cause early increases in blood flow and pressure may result in greater hemorrhage and mortality than those regimens that yield comparable flow and pressure increases late in resuscitation. Future resuscitation research is likely to focus on improvements in fluid composition and adjuncts to administration of large volume of fluid.
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Affiliation(s)
- Bryan A Cotton
- Department of General Surgery, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
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Magdesian KG, Fielding CL, Madigan JE. Measurement of plasma colloid osmotic pressure in neonatal foals under intensive care: comparison of direct and indirect methods and the association of COP with selected clinical and clinicopathologic variables. J Vet Emerg Crit Care (San Antonio) 2004. [DOI: 10.1111/j.1534-6935.2004.04009.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 2002; 89:622-32. [PMID: 12393365 DOI: 10.1093/bja/aef220] [Citation(s) in RCA: 408] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- K Holte
- Department of Surgical Gastroenterology, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark
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Jones PA, Bain FT, Byars TD, David JB, Boston RC. Effect of hydroxyethyl starch infusion on colloid oncotic pressure in hypoproteinemic horses. J Am Vet Med Assoc 2001; 218:1130-5. [PMID: 11318365 DOI: 10.2460/javma.2001.218.1130] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of hydroxyethyl starch (HES) on colloid oncotic pressure (pi) during fluid resuscitation of hypoproteinemic horses and to evaluate the clinical usefulness of direct and indirect methods for determination of pi before and after infusion of a synthetic colloid. DESIGN Prospective clinical study. ANIMALS 11 hypoproteinemic horses. PROCEDURE Horses received IV infusions of 8 to 10 ml of a 6% solution of HES/kg (3.6 to 4.5 ml/lb) of body weight during fluid resuscitation. Blood samples were obtained for determination of plasma measured colloid oncotic pressure (pi meas) and plasma total protein and albumin (A) concentrations. Plasma globulin concentration (G) was calculated as the difference between plasma total protein and albumin concentrations. Calculated values for colloid oncotic pressure (piA + G) were determined by use of a predictive nomogram previously developed for horses. RESULTS There was no significant difference between the means of pi meas and piA + G at the beginning of HES infusion. After HES infusion, the mean of pi meas was increased significantly from baseline for 6 hours. Mean plasma total protein and albumin concentrations and piA + G were decreased significantly from baseline for 24 hours. Differences between mean pi meas and piA + G after HES infusion were significant for 24 hours. CONCLUSIONS AND CLINICAL RELEVANCE There was good agreement between plasma pi meas and piA + G in blood samples obtained from hypoproteinemic horses immediately before infusion of HES. Use of a predictive nomogram did not, however, account for the oncotic effect of HES. Results of comparison of pi meas to piA + G after HES infusion suggest that a significant oncotic effect was maintained for 24 hours in the study horses.
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Affiliation(s)
- P A Jones
- Department of Clinical Studies, School of Veterinary Medicine, New Bolton Center, University of Pennsylvania, Kennett Square, PA 19348, USA
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Perko MJ, Jarnvig IL, Højgaard-Rasmussen N, Eliasen K, Arendrup H. Electric impedance for evaluation of body fluid balance in cardiac surgical patients. J Cardiothorac Vasc Anesth 2001; 15:44-8. [PMID: 11254839 DOI: 10.1053/jcan.2001.20272] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether electric impedance can be used to monitor body fluid balance and fluid distribution in cardiac surgical patients. DESIGN Prospective clinical study. SETTING Heart Center, Rigshospital, Copenhagen. PARTICIPANTS Sixteen consecutive patients scheduled for cardiac surgery. MEASUREMENTS AND MAIN RESULTS Body weight, fluid balance, central hemodynamics, and total and segmental body impedance were examined perioperatively. During semisupine rest before surgery, changes in impedance indicated relocation of fluid from the legs to the thorax, mostly in the extracellular space. After surgery, weight and fluid balance increased by 3.87 +/- 0.35 kg and 1.86 +/- 0.16 L (mean +/- SE, p < 0.01) and remained elevated through the next 2 days. Impedance decreased by 30% over the thorax, by 24% over the abdomen, by 2% over the leg, and by 4% over the entire body. Changes in total and thoracoabdominal impedances had the highest correlation to the fluid balance (r = -0.86 and r = -0.87). After correction of impedance values by the constant from the regression model, the mean difference in estimation of fluid changes obtained by electric impedance and by fluid balance was 0 +/- 0.1 L at the range of changes of 4.6 L. CONCLUSION Alterations in electric impedance closely follow changes in fluid balance during the perioperative period. This method can be used in clinical practice to control postoperative body fluid balance in cardiac surgical patients.
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Affiliation(s)
- M J Perko
- Department of Cardiothoracic Surgery, Heart Center, Rigshospital, Copenhagen, Denmark
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Bumpus SE, Haskins SC, Kass PH. Effect of Synthetic Colloids on Refractometric Readings of Total Solids. J Vet Emerg Crit Care (San Antonio) 1998. [DOI: 10.1111/j.1476-4431.1998.tb00131.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Blanloeil Y, Leteurnier Y, François T. [Indications and role of albumin for vascular loading during postoperative intensive care]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1996; 15:497-506. [PMID: 8881490 DOI: 10.1016/0750-7658(96)83212-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Prospective clinical trials comparing human albumin to other plasma volume expanders during the three first postoperative days in adult patients were analysed. Fifteen studies were selected. Nine of them concerned the evaluation during the immediate postoperative period, after cardiac surgery with cardiopulmonary bypass (CPB). Only one trial referred to hyperoncotic albumin and therefore did not allow to produce recommendations. However, a priori hyperoncotic albumin should not be used for plasma volume expansion. All other studies compared isooncotic albumin to crystalloid or hydroxyethylstarches (HES). It is concluded that albumin can be recommended neither after vascular (aortic abdominal surgery), nor abdominal surgery and can be replaced by Ringer lactate solution in a volume 1.5 to 2 times higher than with albumin. After cardiac surgery, mainly uncomplicated coronary artery bypass graft or valve replacement, albumin can be substituted by HES. These conclusions are only valid for blood losses below 50% of blood volume. The place of isooncotic albumin for fluid resuscitation in case of blood loss exceeding 50% of blood volume cannot be specified.
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Affiliation(s)
- Y Blanloeil
- Service d'anesthésie et de réanimation chirurgicale, CHU Nantes, France
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Bourchier RG, Gloviczki P, Larson MV, Wu QH, Hallett JW, Ahlquist DA, Pairolero PC. The mechanisms and prevention of intravascular fluid loss after occlusion of the supraceliac aorta in dogs. J Vasc Surg 1991. [DOI: 10.1016/0741-5214(91)90347-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Böck JC, Barker BC, Clinton AG, Wilson MB, Lewis FR. Post-traumatic changes in, and effect of colloid osmotic pressure on the distribution of body water. Ann Surg 1989; 210:395-403; discussion 403-5. [PMID: 2774710 PMCID: PMC1358010 DOI: 10.1097/00000658-198909000-00015] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study was to define the post-traumatic changes in body fluid compartments and to evaluate the effect of plasma colloid osmotic pressure (COP) on the partitioning of body fluid between these compartments. Forty-two measurements of plasma volume (green dye), extracellular volume (bromine), and total body water (deuterium) were done in ten traumatized patients (mean Injury Severity Score, ISS, = 34) and 23 similar control studies were done in eight healthy volunteers who were in stable fluid balance. Interstitial volume, intracellular volume, and blood volume were calculated from measured fluid spaces and hematocrit; COP was directly measured. Studies in volunteers on consecutive days indicated good reproducibility, with coefficients of variation equal to 3.5% for COP, 6.3% for plasma volume, 4.5% for extracellular volume, and 4.9% for total body water. COP values extended over the entire range seen clinically, from 10 to 30 mmHg. Interstitial volume was increased by 55% in patients, but intracellular volume was decreased by 10%. We conclude (1) that posttraumatic peripheral edema resulting from hemodilution is located in the interstitial compartment, with no intracellular space expansion; and (2) that interstitial volume, but not intracellular volume, is closely related to plasma COP.
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Affiliation(s)
- J C Böck
- University of California, San Francisco
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Reusser P, Wolff G. Intracapillary colloid osmotic pressure. Intensive Care Med 1988; 14:675. [PMID: 3183197 DOI: 10.1007/bf00256779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Blauhut B, Lundsgaard-Hansen P. Akuter Blutverlust und Verbrennungen in der operativen Medizin. TRANSFUSIONSMEDIZIN 1988. [DOI: 10.1007/978-3-662-10601-3_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Hillman K. A reply. Anaesthesia 1987. [DOI: 10.1111/j.1365-2044.1987.tb04092.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bennett AJ. Peri-operative fluids. Anaesthesia 1987; 42:570-2. [PMID: 3592203 DOI: 10.1111/j.1365-2044.1987.tb04091.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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