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Effects of Colloid or Crystalloid Administration on Pulmonary Extravascular Water in the Postoperative Period After Coronary Artery Bypass Grafting

The Departments of Anesthesia and Radiology, Deborah Heart and Lung Center, Browns Mills, New Jersey, and the Department of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

The effect of postoperative fluid management on pulmonary extravascular thermal volume (ETV₁) as in index of pulmonary extravascular water after coronary artery bypass grafting was compared, using the thermal-dye technique, among five patients who received 5% albumin (group A), five patients who received 6% hydroxyethyl starch (group H), and five who received lactated Ringer's solution (group C). lntraoperatively, all patients received lactated Ringer's solution intravenously, and the cardiopulmonary bypass (CPB) circuit prime included 5% albumin. No statistically significant changes in ETV₁ occurred postoperatively in any group, nor did ETV₁ differ significantly between groups. After CPB, colloid osmotic pressure (COP) significantly decreased and pulmonary artery wedge pressure (WP) and the WP-COP gradient significantly increased in each group, implying an increase in transcapillary fluid flux. Cardiac index_. changed variably. Pulmonary shunt fraction (Qsp/Qt) did not change in groups A and C but decreased during CPB in group H (from 0.22 ± 0.03 to 0.16 ± 0.11). Postoperatively, patients in the three groups received similar volumes of fluids and had similar perioperative weight gains. By the next morning (AM₁), COP increased in all groups, returning to levels noted before CPB in group C, and exceeding these levels in groups A and H. Wedge pressure was similar in all three groups on AM₁. PaO₂ decreased significantly, and alveolar-arterial oxygen partial pressure difference increased significantly in all groups on AM₁. In Group H, Qsp/Qt returned to levels observed before CPB by AM₁ (0.27 ± 0.09). We conclude that in patients without postoperative increases in WP, ETV₁ changes minimally during CPB and is not influenced by the type of fluid administered as the primary volume replacement in the postoperative period.

Key Words: FLUID BALANCE—albumin, crystalloid, hydroxyethyl starch. • LUNG—extravascular water. • SURGERY—cardiovascular.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999