Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery

Abstract

Provided that fluid overloading is prevented, the type of fluid used for volume loading does not affect pulmonary permeability and oedema, in patients with acute lung injury after cardiac or major vascular surgery, except for HES that may ameliorate increased permeability. During fluid loading, changes in LIS (and respiratory compliance) do not represent changes in pulmonary permeability or oedema.

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

“…Our study does not address the effect of mathematical coupling of GEDVI to CI, when volumes are derived from the same transpulmonary dilution curve as cardiac output. The often observed superiority of cardiac volumes over filling pressures in predicting and monitoring cardiac output responses, that is, fluid responsiveness, may indeed be overestimated by the phenomenon, as recently described by our group also [1,6-8,10-16,18,19,27]. In hearts with systolic dysfunction and dilatation, a right- and downward shift on the Frank-Starling curve and along the curvilinear pressure-volume relationship at end-diastole, preload recruitability may be more dependent on and thus predicted and monitored by pressures than by volumes [5,22].…”

“…Since our analyses adjusted for amount and type of fluids, it is unlikely that small differences in the amounts of fluids (mean 100 mL when GEF was <20%, for instance) rather than differences in cardiac preloading, were responsible for different increases in CI (of 0.6 L/minute/m 2 when GEF was <20%) in responding versus non-responding fluid loading events. The fluid loading protocol guided by changes in filling pressures was used to prevent deleterious fluid overloading rather than to guide treatment on the basis of fluid responsiveness, as recently advocated to ensure safety [23,26,27]. By virtue of its design, the study did not address the potential clinical benefits of one hemodynamic monitoring technique over the other.…”

“…Reproducibility of these measurements is typically within 10% [1]. After baseline measurements were taken, fluids were given over 90 minutes on the basis of the response within predefined limits of increases in pressures (CVP or - when available - PAOP), according to a previously described protocol [23,26,27]. Up to 200 mL of fluid were given every 10 minutes, provided that the increase in filling pressures with the fluid loading did not exceed critical values, and this policy has been proven safe in previous studies (that is, not evoking pulmonary edema) [23,26,27].…”

Volume Management and Resuscitation in Thoracic Surgery

“…Some beneficial effects on pulmonary parameters have been demonstrated, including pulmonary permeability [102,103], histological findings [104], reductions in VILI and pulmonary edema [105], and more rapid hemodynamic stabilization [103]. However, in a large systematic review of burns, trauma, and surgical patients, no outcome benefit of colloids could be demonstrated, and hydroxyethyl starch (HES) was found to possibly increase mortality [106].…”

Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

“…The capacity of gelatin to maintain hemodynamics has been studied in experimental and clinical investigations (Marx et al 2002, Verheij et al 2006b). Kröll and co-workers had already shown in 1993 that the volume expansion effect of 500 mL of gelatin in healthy volunteers is significantly inferior to that of HES and even shorter than that of crystalloid solution (Ringer).…”