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Abstract
We compared the response of the pulmonary microcirculation to fluid overload before
and 24 hours after hemorrhagic shock, resuscitated with either blood or crystalloid,
to determine whether vascular permeability was altered, making the lung more susceptable
to fluid overload after shock and whether this response differed depending on the
type of resuscitation fluid. Fourteen unanesthetized sheep with chrome lung lymph
fistula were given a fluid challenge (one half of blood volume) before and 24 hours
after hemorrhagic shock. Seven sheep were resuscitated after shock with shed blood
and seven sheep were resuscitated with Ringer's lactate alone equal to 2.5 times the
amount of shed blood. Pulmonary vascular pressures and lung lymph flow Q̇l were at baseline in both groups 24 hours after resuscitation except for the decreased
plasma oncotic pressure πp in the crystalloid group. Interstitial oncotic pressure,
πi was also lowered in this group such that the gradient (πp-πi) remained at baseline.
In the blood group, pulmonary vascular pressures and QL increased transiently after fluid loading before and after shock with the mean time
for Q̇L to return to baseline being 5.5 and 5.9 hours for the preshock and postshock periods,
respectively. In the crystalloid group, fluid loading after shock produced an increase
in pulmonary vascular pressures resulting in a significant increase in Q̇L over the preshock fluid response with the mean time for Q̇L to return to baseline being 10.1 hours. However, changes in the value of (πp-πi)
were identical to those seen before shock. Therefore we noted that 24 hours after
shock, lung permeability was not significantly altered but crystalloid resuscitation
did make the lung more susceptible to volume overload.
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References
- Fluid resuscitation following injury: rationale for the use of balanced salts solution.Crit Care Med. 1976; 4: 46-54
- Pulmonary microvascular response to hemorrhagic shock, resuscitation and recovery.J Appl Physiol. 1979; 46: 498-503
- The effect of plasma oncotic pressure on the pulmonary microcirculation after hemorrhagic shock.Surgery. 1979; 86: 323-329
- Determination of serum albumin.in: Standard methods of clinical chemistry. vol 7. Academic Press Inc, New York1972: 175-188
- Effect of increased vascular pressure on lung fluid balance in unanesthetized sheep.Circ Res. 1975; 37: 271-284
- The effect of intravenously administered albumin on dogs with pulmonary interstitial edema.Surg Gynecol Obstet. 1973; 137: 593-596
- Cardiorespiratory consequences of corrected gradual severe blood loss in unanesthetized sheep.J Appl Physiol. 1966; 21: 589-596
- Extravascular lung water following hemorrhagic shock in the baboon: comparison of Ringer's lactate and plasmanate.Ann Surg. 1974; 180: 408-417
- Pulmonary intravascular and extravascular volume in hemorrhagic shock and fluid replacement.Surgery. 1972; 72: 780-787
- Acute respiratory failure in the adult.N Engl J Med. 1972; 287: 690
- Acute respiratory failure in the adult.N Engl J Med. 1972; 287: 743
- Acute respiratory failure in the adult.N Engl J Med. 1972; 287: 799
- Colloid osmotic and pulmonary wedge pressured in acute respiratory failure following hemorrhage.Surg Gynecol Obstet. 1978; 146: 537-540
- Pulmonary edema after replacement of blood loss by electrolyte solutions.Surg Gynecol Obstet. 1972; 135: 893
- Comparison of the relative effectiveness of whole blood transfusions and various types of fluid therapy in resuscitation.Crit Care Med. 1976; 4: 71-78
- The role of albumin and oncotically active fluids in shock.Crit Care Med. 1976; 4: 55-61
- Steady state pulmonary transvascular water filtration in unanesthetized sheep.Cric Res. 1971; 28: 135-139
- Pulmonary edema.Physiol Rev. 1974; 54: 678-811
- Preparation of chronic lung lymph fistulas in sheep.J Surg Res. 1975; 19: 315-320
- Lung lymph and free interstitial fluid protein composition in sheep with edema.Am J Physiol. 1976; 230: 1650-1653
- Routine plasma colloid osmotic pressure measurements.Crit Care Med. 1974; 2: 229-234
Article info
Publication history
Accepted:
September 14,
1979
Footnotes
☆Supported by National Institutes of Health grant No. HL271076, Bethesda, Md.
Identification
Copyright
© 1980 Published by Elsevier Inc.
