Biomaterial Database

[Resuscitation and extravascular lung fluid in cardiac surgery]. 1988

J Boldt, and D Kling, and B von Bormann, and H H Scheld, and G Hempelmann

Abteilung Anaesthesiologie und operative Intensivmedizin, Justus-Liebig-Univeristät Giessen.

Cardiovascular arrest may be followed by severe respiratory insufficiency due to an increase in the pressure in the pulmonary vascular system, an alteration in capillary permeability, or both. Extracorporeal circulation (ECC), on the other hand, can lead to a change in capillary integrity ('capillary leakage') caused by the unphysiologic perfusion patterns and/or activation of various mediator systems. Pulmonary hyperhydration (increased extravascular lung water [EVLW]) seems to be the most important factor limiting pulmonary function in this situation. This retrospective study was designed to investigate the influence of resuscitation in the period before ECC on pulmonary EVLW thereafter. Eight coronary surgery patients who had to be resuscitated in the period before the start of ECC due to cardiocirculatory arrest were compared to 8 patients without resuscitation selected randomly (control group). There were no differences between the two groups with regard to age, catheterization data, and ECC conditions. All patients underwent identical monitoring, including estimation of EVLW. Lung water measurement was performed by the thermal dye technique with indocyanine green (= non-diffusible indicator) dissolved in ice-cold dextrose (= diffusible indicator) and a bedside microprocessor before resusciation and after ECC (15 min, 45 min, 5h). Simultaneously, hemodynamics and parameters of pulmonary gas exchange were monitored. Baseline values of EVLW were comparable in both groups. After ECC a transient increase in EVLW could be demonstrated in the controls, indicating an altered fluid flux even in 'uncomplicated' courses; 5 h after ECC lung water content had again reached baseline values. In contrast, there was a significant increase in EVLW in the 'complicated group' immediately after ECC (+2.60 ml/kg) and 5 h after ECC (+1.38 ml/kg); in consequence, the paO2 was significantly decreased (-180 mmHg) while Qs/Qt was increased (+6.79%). It is concluded that the combination of two factors that potentially damage pulmonary tissue and increase lung water content (reanimation due to circulatory arrest and extracorporeal circulation) lead to a significant increase in extravascular lung water combined with a deterioration of pulmonary function, resulting in severe respiratory failure.

UI	MeSH Term	Description	Entries
D007431	Intraoperative Complications	Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure.	Peroperative Complications,Surgical Injuries,Complication, Intraoperative,Complication, Peroperative,Injuries, Surgical,Complications, Intraoperative,Complications, Peroperative,Injury, Surgical,Intraoperative Complication,Peroperative Complication,Surgical Injury
D008168	Lung	Either of the pair of organs occupying the cavity of the thorax that effect the aeration of the blood.	Lungs
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D011654	Pulmonary Edema	Excessive accumulation of extravascular fluid in the lung, an indication of a serious underlying disease or disorder. Pulmonary edema prevents efficient PULMONARY GAS EXCHANGE in the PULMONARY ALVEOLI, and can be life-threatening.	Wet Lung,Edema, Pulmonary,Edemas, Pulmonary,Pulmonary Edemas,Lung, Wet,Lungs, Wet,Wet Lungs
D012128	Respiratory Distress Syndrome	A syndrome characterized by progressive life-threatening RESPIRATORY INSUFFICIENCY in the absence of known LUNG DISEASES, usually following a systemic insult such as surgery or major TRAUMA.	ARDS, Human,Acute Respiratory Distress Syndrome,Adult Respiratory Distress Syndrome,Pediatric Respiratory Distress Syndrome,Respiratory Distress Syndrome, Acute,Respiratory Distress Syndrome, Adult,Respiratory Distress Syndrome, Pediatric,Shock Lung,Distress Syndrome, Respiratory,Distress Syndromes, Respiratory,Human ARDS,Lung, Shock,Respiratory Distress Syndromes,Syndrome, Respiratory Distress
D012151	Resuscitation	The restoration to life or consciousness of one apparently dead. (Dorland, 27th ed)	Resuscitations
D002199	Capillary Permeability	The property of blood capillary ENDOTHELIUM that allows for the selective exchange of substances between the blood and surrounding tissues and through membranous barriers such as the BLOOD-AIR BARRIER; BLOOD-AQUEOUS BARRIER; BLOOD-BRAIN BARRIER; BLOOD-NERVE BARRIER; BLOOD-RETINAL BARRIER; and BLOOD-TESTIS BARRIER. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (TIGHT JUNCTIONS) which may limit large molecule movement.	Microvascular Permeability,Permeability, Capillary,Permeability, Microvascular,Vascular Permeability,Capillary Permeabilities,Microvascular Permeabilities,Permeabilities, Capillary,Permeabilities, Microvascular,Permeabilities, Vascular,Permeability, Vascular,Vascular Permeabilities
D005110	Extracellular Space	Interstitial space between cells, occupied by INTERSTITIAL FLUID as well as amorphous and fibrous substances. For organisms with a CELL WALL, the extracellular space includes everything outside of the CELL MEMBRANE including the PERIPLASM and the cell wall.	Intercellular Space,Extracellular Spaces,Intercellular Spaces,Space, Extracellular,Space, Intercellular,Spaces, Extracellular,Spaces, Intercellular
D005112	Extracorporeal Circulation	Diversion of blood flow through a circuit located outside the body but continuous with the bodily circulation.	Circulation, Extracorporeal,Circulations, Extracorporeal,Extracorporeal Circulations
D006323	Heart Arrest	Cessation of heart beat or MYOCARDIAL CONTRACTION. If it is treated within a few minutes, heart arrest can be reversed in most cases to normal cardiac rhythm and effective circulation.	Asystole,Cardiac Arrest,Cardiopulmonary Arrest,Arrest, Cardiac,Arrest, Cardiopulmonary,Arrest, Heart,Asystoles