Blood volume prior to and following treatment of acute cardiogenic pulmonary edema.

Abstract

Following onset of acute cardiogenic pulmonary edema in 21 patients, increases in hematocrit, plasma protein concentration, and colloid osmotic pressure were associated with decreases in plasma volume. Accordingly, there was a loss of hypo-oncotic fluid into the extravascular spaces. Following treatment with oxygen, furosemide, and morphine sulfate and reversal of clinical and radiographic signs of pulmonary edema, declines in hematocrit, plasma protein concentration, and colloid osmotic pressure were associated with increases in plasma volume. Hypo-oncotic edema fluid was therefore reabsorbed into the vascular compartment. The concept that acute heeart failure with pulmonary edema is associated with an increase in intravascular volume is therefore not supported. To the contrary, there is a reduction of blood volume during acute pulmonary edema. During reversal of acute pulmonary edema with diuresis, there was re-expansion rather than contraction of blood volume.

Value of the plasma protein and hemoglobin concentration in the diagnosis of pulmonary edema in scorpion sting patients

“…These results are in accordance with findings of previous studies performed in patients with cardiogenic pulmonary edema related to usual causes of left ventricular dysfunction [6,7,8,18].…”

“…In patients with cardiogenic pulmonary edema Figueras and Weil [8] reported lower values of plasma and total blood volumes measured using isotopic methods and higher values of colloid osmotic pressure, total protein concentration, and hematocrit than in patients without cardiogenic pulmonary edema. Similar findings have been reported in other series of patients with acute cardiogenic pulmonary edema [6,7,18]. In our study the resolution of pulmonary edema under treat-1603 above 18 mmHg in the five patients who underwent pulmonary artery catheterization.…”

“…Cardiogenic pulmonary edema formation results from an increase in pulmonary capillary hydrostatic pressure related to an increase in left ventricular filling pressure [6,7,8]. Fluid filtration across the pulmonary capillaries sometimes reaches 50% of the normal plasma volume [6].…”

“…Fluid filtration across the pulmonary capillaries sometimes reaches 50% of the normal plasma volume [6]. In cardiogenic pulmonary edema the protein concentration in this fluid is low and approximately one-half of that in the plasma [6,7,8]. Accordingly, filtration of a large amount of hypo-oncotic fluid into the lung would result in both a reduction in plasma volume and an increase in hemoglobin and plasma protein concentrations.…”

“…Therefore, in some cases a complementary tool may be necessary for diagnostic confirmation. Previous studies indicate that acute cardiogenic pulmonary edema is associated with an increase in total plasma protein and hemoglobin concentrations because of the transfer of hypo-oncotic fluid from the intravascular compartment into the lung interstitium [6,7,8].…”