Summary
We studied patients undergoing A-C Bypass with haemodilution. The bubble oxygenator was primed with either two units of plasma and lactated Ringer’s solution (PLASMA) or with lactated Ringer’s solution (RINGER’S) alone. We found no difference in pulmonary function or lung water determinations between the Ringer’s and the Plasma groups. When all patients were grouped together we found no significant increase in lung water (ETVL)5 immediately post-operatively. This suggests lung water did not increase during cardiopulmonary bypass. By the following morning there was a highly significant increase in lung water which was related to changes in the balance between hydrostatic pressure and colloid osmotic pressure and which continued through the second post-operative day. Pulmonary dysfunction, as measured by gas exchange, was not a major problem except in one patient whose lung water increase exceeded 3 ml H2O/kg of total body weight (52 per cent increase) and in whom there was increased shunting. We consider the increase in lung water important, since it may reduce lung compliance and further lung water accumulation. Since the increased lung water was associated with a change in the balance of Starling’s forces (PMV — COPmy ), treatment designed to reduce that balance should reduce lung water accumulation.
Résumé
Chez 17 malades opérés pour pontage aorto-coronarien, nous avons voulu mesurer ľeffet de ľhémodilution occasionnée par la circulation extra-corporelle sur le volume ďeau pulmonaire extra-vasculaire (ETVl).
Ľoxygénateur à bulles a été amorce avec un mélange de lactate ringer et de plasma (deux flacons) dans un premier groupe et avec du lactate seul dans un deuxième.
On n’a décelé aucune différence entre les deux groupes au plan de la fonction pulmonaire post-opératoire et des volumes ďeau pulmonaire extra-vasculaire. Lorsqu’on réunit ces malades en un groupe unique, on ne décèle pas ďaugmentation de ľeau pulmonaire extra-vasculaire dans les suites opératoires immédiates. Ceci tendrait à démontrer que la circulation extra-corporelle comme telle ne produit pas ďextravasation ďeau au niveau du poumon. Le lendemain matin cependant, ľaugmentation de ľeau pulmonaire extra-vasculaire était nettement significative et rattachable à des changements dans ľéquilibre des forces hydrostatiques et osmotiquese. Cette augmentation continua à se manifester au deuxième jour post-opératoire.
La mesure des échanges gazeux n’a pas montré ďinsuffisance pulmonaire importante à ľexception ďun seul malade dont ľaugmentation de ľeau pulmonaire extra-vasculaire a dépassé les 3 ml/kilo (augmentation de 52 pour cent) et chez qui on a aussi mis en évidence une augmentation de shunt intra-pulmonaire.
Nous considérons que ľaugmentation de ľeau pulmonaire extra-vasculaire revèt une importance particulière car elle entraîne une diminution de la compliance pulmonaire et ainsi mène à une plus grande accumulation ďeau extra-vasculaire.
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J., R., J., B., Kay, C. et al. Extra vascular lung water accumulation in patients following coronary artery surgery. Canad. Anaesth. Soc. J. 24, 332–345 (1977). https://doi.org/10.1007/BF03005106
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DOI: https://doi.org/10.1007/BF03005106