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CARDIOVASCULAR
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Volume 3, 1998, No 3/4 |
Changes of Total Body
Water and Plasma Colloid-Osmotic Pressure During and after
Open-Heart Surgery in Children
V. Kucera, V.
Chaloupecký, P. Vojtovic, I. Cerná, T. Tláskal, M. Kostelka,
H. Tomášová, I. Konícková, B. Hucín
Background: The superiority of colloid or non-colloid priming solution for cardiopulmonary bypass ( CPB ) is controversial. Supporters of colloid priming fluids argue that physiological colloid-osmotic pressure ( COP ) in plasma keeps the pressure balance ( Starling forces) across the capillary wall, thus preventing tissue edema. Opponents object that increased capillary permeability due to general inflammatory response to CPB may cause leaking of proteins to extravascular space and increase of COP in the interstitial fluid.The aim of our study was to measure total body water (TBW) and COP in the different stages of CPB and post-operative period in children operated on for congenital heart defects (CHD).
Method: Thirty-three patients were studied and divided into 3 groups according to the type of CHD and the kind of priming fluid. Group A: N= 14; atrial and ventricular septal defects (ASD, VSD); priming fluids Hemaccel and Ringer´s solution. Group B: N = 12; transposition of the great arteries ( TGA ); priming fluids packed red cells, fresh human plasma and small portion of Ringer´s solution ( 6 ml/kg ). Group C: N = 7; functional single ventricle ( SV ); priming solution Hemaccel, Ringer´s solution, 20% albumin.
We measured TBW by body bioelectrical impedance (BBI), COP directly in colloid osmometer, hematocrit and body temperature in 5 periods, before, during and after the operation. The fluid balance was calculated from the patient´s intake and output data in 4 periods between every periodical measurement of TBW, COP and hematocrit.
Results: We found accumulation of TBW in all groups before the end of CPB. On the 1st post-operative day TBW declined in group A, remained unchanged in group B and further increased in group C. On the 2nd post-op. day TBW normalized in groups A and B, decreased in group C but only to + 31% of the preoperative value. COP significantly decreased during CPB in groups A and C and it returned to the preoperative values on the 1st post-op. day. In group B there was a significant decrease of COP at the beginning of CPB, it normalized up to the end of CPB and further remained within normal range. Total fluid balance was positive in all groups during CPB and on the day of surgery. Measurements of TBW corresponded with the periodical recordings of total fluid balance.
Conclusions: BBI is a satisfactory non-invasive method for a bedside estimation of TBW after cardiac operations in children. Accumulation of TBW was observed in all groups during CPB and on the day of surgery. The use of a blood colloid prime and normal plasma COP during CPB did not prevent postoperative TBW accumulation. The trend of normalization of TBW was observed from the 2nd post-op. day onwards.
Key words: cardiopulmonary bypass prime, hemodilution, total body water, body bioelectrical impedance, plasma colloid osmotic pressure
Reference:
(CVE. 1998; 3 (3/4): 149-153)
Address for Correspondence:
Vladimír Kucera, M.D., Ph.D.
Kardiocentrum, University Hospital Motol
Vúvalu 84,
CZ-15018 Prague 5 Czech Republic
E-mail: vladimír kucera@fmotol.cuni.cz
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