Background
Hemorrhagic hypotension or operative trauma is believed to cause a contraction of
the extracellular fluid volume (ECV) beyond the measured fluid losses. The aim of
this review was to explore the evidence and implications of ECV loss.
Methods
We performed a systematic review of original trials measuring ECV changes during hemorrhage
or operation. PubMed, relevant periodicals, and reference lists were searched until
no further original articles appeared. The quality of both the scientific and the
technical methods of the trials were evaluated.
Results
A total of 61 original articles were found. The pattern appeared that all investigators
reporting shock or operation to cause a disparate reduction of the ECV had measured
the ECV with the same method. The ECV was calculated from very few blood samples that
were withdrawn after 20 to 30 minutes of equilibration of a tracer (the 35SO4-tracer). Trials calculating ECV from multiple blood samples, after longer equilibration
times, or using other tracers did not find a contraction of the ECV. On the contrary,
trials using a bromide tracer found the ECV to be expanded after operation.
Conclusions
The evidence supporting the idea that hemorrhage or operation cause a contraction
of the ECV is weak, and probably a result of flawed methodology.
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Article info
Publication history
Accepted:
July 29,
2005
Received in revised form:
July 19,
2005
Received:
July 22,
2004
Footnotes
Supported by the Eastern Danish Health Science Research Forum, University of Copenhagen; Clinical Unit of Preventive Medicine and Health Promotion, Bispebjerg University Hospital; The Copenhagen Hospital Corporation, Council of Research; The Danish Hospital Foundation for Medical Research, Region of Copenhagen, The Faeroe Islands and Greenland; The Danish Medical Association Research Found; The Northern Jut land Council of Research; The Research and Development Council, Vejle County; Olga Bryde Nielsen’s Fond; Hans and Nora Buchard’s Fond; Inge and Jorgen Larsen’s Mindelegat; and Grosserer Valdemar Foersom and wife Thyra Foersom’s fond.
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
