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High-Volume vs Standard Fluid Therapy in a Septic Pig Model: Impact on Pulmonary Function

High-Volume vs Standard Fluid Therapy in a Septic Pig Model: Impact on Pulmonary Function Abstract Objective: To compare pulmonary function and peripheral organ blood flow in septic pigs receiving high-volume fluid resuscitation or standard-volume fluid resuscitation with similar goals in oxygen delivery. Design: A prospective study comparing 2 groups of septic pigs. Setting: A university animal research laboratory. Subjects: Eleven septic pigs. Interventions: Basal oxygen delivery was increased from 450 to 550 mL/min to at least 600 mL/min by the sixth hour and maintained for 24 hours. From a baseline pulmonary artery occlusion pressure (PAOP) measurement of approximately 6 mm Hg, the high-volume group (n=5) was treated until a PAOP measurement of 12 mm Hg was reached and the standard-volume group (n=6) was treated until a PAOP measurement of 8 mm Hg was reached. Blood transfusions and inotropic agents were added as necessary to reach the oxygen delivery goal. Results: The high-volume group had a significantly greater positive fluid balance, greater weight gain, and a higher PAOP but similar intrapulmonary shunt and extravascular lung water as compared with the standard-volume group. Conclusion: Resuscitation with large volumes of fluid in early sepsis with a physiological goal of a higher PAOP to augment oxygen delivery did not cause increased pulmonary edema and oxygenation deficit compared with maintenance of lower cardiac filling pressures.Arch Surg. 1997;132:1111-1115 References 1. Baue AE. The horror autotoxicus and multiple-organ failure . Arch Surg . 1992; 127:1451-1462.Crossref 2. Prewitt RM, McCarthy J, Wood LDH. Treatment of acute low pressure pulmonary edema in dogs . J Clin Invest . 1981;67:409-418.Crossref 3. Gottlieb SS, Wood LDH, Hansen DE, Long R. The effect of introprusside on pulmonary edema, oxygen exchange, and blood flow in hydrochloric acid aspiration . Anesthesiology . 1987;67:203-210.Crossref 4. Sznajder JI, Zucker AR, Wood LDH, Long GR. The effects of plasmapheresis and hemofiltration on canine acid aspiration pulmonary edema . Am Rev Respir Dis . 1986;134:222-228. 5. Sivak ED, Tita J, Meden G, et al. Effects of furosemide versus isolated ultrafiltration on extravascular lung water in oleic acid—induced pulmonary edema . Crit Care Med . 1986;14:48-51.Crossref 6. Simmons RS, Berdine GG, Seidenfield JJ, et al. Fluid balance and the adult respiratory distress syndrome . Am Rev Respir Dis . 1987;1135:924-929. 7. Lowell JAS, Schifferdecker C, Driscoll DF, et al. Postoperative fluid overload: not a benign problem . Crit Care Med . 1990;18:728-733.Crossref 8. Humphrey H, Hall J, Sznajder I, et al. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure . Chest . 1990;97: 1176-1180.Crossref 9. Eisenberg PR, Hansbrough JR, Anderson, D, Schuster DP. A prospective study of lung water measurements during patient management in an intensive care unit . Am Rev Respir Dis . 1987;136:662-668.Crossref 10. Schuller D, Mitchell JP, Calandrino FS, Schuster DP. Fluid balance during pulmonary edema . Chest . 1991;100:1068-1075.Crossref 11. Mitchell JP, Schuller D, Calandrino FS, Schuster DP. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization . Am Rev Respir Dis . 1992;145:990-996.Crossref 12. Chien S, Dellenback RJ, Usami S, Treitel K, Chang C, Gregersen MI. Blood volume and its distribution in endotoxin shock . Am J Physiol . 1966:210:1411-1418. 13. Groeneveld ABJ, Heidendal GAK, Hollander Wd, Nauta JJP, Thijs LG. Noninvasive assessment of regional albumin extravasation in porcine septic shock . J Crit Care . 1987;2:245-255.Crossref 14. Hickling KG, Henderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome . Intensive Care Med . 1990;16:372-377.Crossref 15. Carcillo JA, Davis AL, Zaritsky A. Role of early fluid resuscitation in pediatric septic shock . JAMA . 1991;266:1242-1245.Crossref 16. Sibbald WJ, Vincent Jean-Louis. Roundtable conference on clinical trials for the treatment of sepsis . Crit Care Med . 1995;23:394-399.Crossref 17. Hoban LD, Paschall JA, Eckstein J, et al. Awake porcine model of intraperitoneal sepsis and altered oxygen utilization . Circ Shock . 1991;34:252-262. 18. Pearce ML, Yamashita J, Beazelt J. Measurement of pulmonary edema . Circ Res . 1965;16:482-488.Crossref 19. Borg T, Alvors A, Gerdin B, Modig J. A porcine model of early adult respiratory distress syndrome induced by endotoxaemia . Acta Anesthesiol Scand . 1985;28:814-830.Crossref 20. Montgomery AB, Stager MA, Carrico J, Hudson LD. Causes of mortality in patients with the adult respiratory distress syndrome . Am Rev Respir Dis . 1985; 132:485-489. 21. Bishop MH, Shoemaker WC, Appel PL, et al. Relationship between supranormal circulatory values, time delays, and outcome in severely traumatized patients . Crit Care Med . 1993;21:56-63.Crossref 22. Yu M, Levy MM, Smith P, Takiguchi SA, Miyasaki A, Myers SA. Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study . Crit Care Med . 1993;21:830-838.Crossref 23. Moore FA, Haenel JB, Moore EE, Whitehill TA. Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure . J Trauma . 1992;33:58-67.Crossref 24. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients . Chest . 1988;94:1176-1186.Crossref 25. Boyd O, Grounds RM, Bennett ED. A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients . JAMA . 1993:270:2699-2707.Crossref 26. Tuchsmidt J, Fried J, Astiz M, Rackow E. Elevation of cardiac output and oxygen delivery improves outcome in septic shock . Chest . 1992;102:216-220.Crossref 27. Fleming A, Bishop M, Shoemaker W, et al. Prospective trial of supranormal values as goals of resuscitation in severe trauma . Arch Surg . 1992;127:1175-1181.Crossref 28. Yu M, Yakanishi D, Myers SA, et al. Frequency of mortality and myocardial infarction during maximizing oxygen delivery: a prospective randomized trial . Crit Care Med . 1995;23:1025-1032.Crossref 29. Brigham KL, Karima K, Harris TR, et al. Correlation of oxygenation with vascular permeability—surface area but not with lung water in humans with acute respiratory failure and pulmonary edema . J Clin Invest . 1983;72:339-349.Crossref 30. Lava J, Rice CL, Moss GS, et al. Pulmonary dysfunction in sepsis: is pulmonary edema the culprit? J Trauma . 1982;22:280-284.Crossref 31. Bock JC, Barker BC, Lewis FR. Effects of furosemide on extravascular lung water, pulmonary gas exchange, mechanics, and hemodynamics in posttraumatic non-cardiogenic pulmonary edema . J Trauma . 1992;33:149. 32. Shoemaker WC, Appel P, Czer LSC, Bland R, Schwartz S, Hopkins JA. Pathogenesis of respiratory failure (ARDS) after hemorrhage and trauma, I: cardiorespiratory patterns preceding the development of ARDS . Crit Care Med . 1980;8: 504-512.Crossref 33. Shoemaker WC, Appel PL, Bishop MH. Temporal patterns of blood volume, hemodynamics, and oxygen transport in pathogenesis and therapy of postoperative adult respiratory distress syndrome . New Horiz . 1993;1:522-537. 34. Jardin F, Eveleigh MC, Gurdjian F, Delille F, Margairaz A. Comparative effects of blood volume expansion, dopamine infusion and isoproterenol infusion on mismatching of ventilation and pulmonary blood flow in peritonitis . Circulation . 1979; 60:155-159.Crossref 35. Barzotta AP, Polk HC. Multiple system organ failure . Surg Clin North Am . 1983; 63:315-336. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

High-Volume vs Standard Fluid Therapy in a Septic Pig Model: Impact on Pulmonary Function

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430340065010
Publisher site
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Abstract

Abstract Objective: To compare pulmonary function and peripheral organ blood flow in septic pigs receiving high-volume fluid resuscitation or standard-volume fluid resuscitation with similar goals in oxygen delivery. Design: A prospective study comparing 2 groups of septic pigs. Setting: A university animal research laboratory. Subjects: Eleven septic pigs. Interventions: Basal oxygen delivery was increased from 450 to 550 mL/min to at least 600 mL/min by the sixth hour and maintained for 24 hours. From a baseline pulmonary artery occlusion pressure (PAOP) measurement of approximately 6 mm Hg, the high-volume group (n=5) was treated until a PAOP measurement of 12 mm Hg was reached and the standard-volume group (n=6) was treated until a PAOP measurement of 8 mm Hg was reached. Blood transfusions and inotropic agents were added as necessary to reach the oxygen delivery goal. Results: The high-volume group had a significantly greater positive fluid balance, greater weight gain, and a higher PAOP but similar intrapulmonary shunt and extravascular lung water as compared with the standard-volume group. Conclusion: Resuscitation with large volumes of fluid in early sepsis with a physiological goal of a higher PAOP to augment oxygen delivery did not cause increased pulmonary edema and oxygenation deficit compared with maintenance of lower cardiac filling pressures.Arch Surg. 1997;132:1111-1115 References 1. Baue AE. The horror autotoxicus and multiple-organ failure . Arch Surg . 1992; 127:1451-1462.Crossref 2. Prewitt RM, McCarthy J, Wood LDH. Treatment of acute low pressure pulmonary edema in dogs . J Clin Invest . 1981;67:409-418.Crossref 3. Gottlieb SS, Wood LDH, Hansen DE, Long R. The effect of introprusside on pulmonary edema, oxygen exchange, and blood flow in hydrochloric acid aspiration . Anesthesiology . 1987;67:203-210.Crossref 4. Sznajder JI, Zucker AR, Wood LDH, Long GR. The effects of plasmapheresis and hemofiltration on canine acid aspiration pulmonary edema . Am Rev Respir Dis . 1986;134:222-228. 5. Sivak ED, Tita J, Meden G, et al. Effects of furosemide versus isolated ultrafiltration on extravascular lung water in oleic acid—induced pulmonary edema . Crit Care Med . 1986;14:48-51.Crossref 6. Simmons RS, Berdine GG, Seidenfield JJ, et al. Fluid balance and the adult respiratory distress syndrome . Am Rev Respir Dis . 1987;1135:924-929. 7. Lowell JAS, Schifferdecker C, Driscoll DF, et al. Postoperative fluid overload: not a benign problem . Crit Care Med . 1990;18:728-733.Crossref 8. Humphrey H, Hall J, Sznajder I, et al. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure . Chest . 1990;97: 1176-1180.Crossref 9. Eisenberg PR, Hansbrough JR, Anderson, D, Schuster DP. A prospective study of lung water measurements during patient management in an intensive care unit . Am Rev Respir Dis . 1987;136:662-668.Crossref 10. Schuller D, Mitchell JP, Calandrino FS, Schuster DP. Fluid balance during pulmonary edema . Chest . 1991;100:1068-1075.Crossref 11. Mitchell JP, Schuller D, Calandrino FS, Schuster DP. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization . Am Rev Respir Dis . 1992;145:990-996.Crossref 12. Chien S, Dellenback RJ, Usami S, Treitel K, Chang C, Gregersen MI. Blood volume and its distribution in endotoxin shock . Am J Physiol . 1966:210:1411-1418. 13. Groeneveld ABJ, Heidendal GAK, Hollander Wd, Nauta JJP, Thijs LG. Noninvasive assessment of regional albumin extravasation in porcine septic shock . J Crit Care . 1987;2:245-255.Crossref 14. Hickling KG, Henderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome . Intensive Care Med . 1990;16:372-377.Crossref 15. Carcillo JA, Davis AL, Zaritsky A. Role of early fluid resuscitation in pediatric septic shock . JAMA . 1991;266:1242-1245.Crossref 16. Sibbald WJ, Vincent Jean-Louis. Roundtable conference on clinical trials for the treatment of sepsis . Crit Care Med . 1995;23:394-399.Crossref 17. Hoban LD, Paschall JA, Eckstein J, et al. Awake porcine model of intraperitoneal sepsis and altered oxygen utilization . Circ Shock . 1991;34:252-262. 18. Pearce ML, Yamashita J, Beazelt J. Measurement of pulmonary edema . Circ Res . 1965;16:482-488.Crossref 19. Borg T, Alvors A, Gerdin B, Modig J. A porcine model of early adult respiratory distress syndrome induced by endotoxaemia . Acta Anesthesiol Scand . 1985;28:814-830.Crossref 20. Montgomery AB, Stager MA, Carrico J, Hudson LD. Causes of mortality in patients with the adult respiratory distress syndrome . Am Rev Respir Dis . 1985; 132:485-489. 21. Bishop MH, Shoemaker WC, Appel PL, et al. Relationship between supranormal circulatory values, time delays, and outcome in severely traumatized patients . Crit Care Med . 1993;21:56-63.Crossref 22. Yu M, Levy MM, Smith P, Takiguchi SA, Miyasaki A, Myers SA. Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study . Crit Care Med . 1993;21:830-838.Crossref 23. Moore FA, Haenel JB, Moore EE, Whitehill TA. Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure . J Trauma . 1992;33:58-67.Crossref 24. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients . Chest . 1988;94:1176-1186.Crossref 25. Boyd O, Grounds RM, Bennett ED. A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients . JAMA . 1993:270:2699-2707.Crossref 26. Tuchsmidt J, Fried J, Astiz M, Rackow E. Elevation of cardiac output and oxygen delivery improves outcome in septic shock . Chest . 1992;102:216-220.Crossref 27. Fleming A, Bishop M, Shoemaker W, et al. Prospective trial of supranormal values as goals of resuscitation in severe trauma . Arch Surg . 1992;127:1175-1181.Crossref 28. Yu M, Yakanishi D, Myers SA, et al. Frequency of mortality and myocardial infarction during maximizing oxygen delivery: a prospective randomized trial . Crit Care Med . 1995;23:1025-1032.Crossref 29. Brigham KL, Karima K, Harris TR, et al. Correlation of oxygenation with vascular permeability—surface area but not with lung water in humans with acute respiratory failure and pulmonary edema . J Clin Invest . 1983;72:339-349.Crossref 30. Lava J, Rice CL, Moss GS, et al. Pulmonary dysfunction in sepsis: is pulmonary edema the culprit? J Trauma . 1982;22:280-284.Crossref 31. Bock JC, Barker BC, Lewis FR. Effects of furosemide on extravascular lung water, pulmonary gas exchange, mechanics, and hemodynamics in posttraumatic non-cardiogenic pulmonary edema . J Trauma . 1992;33:149. 32. Shoemaker WC, Appel P, Czer LSC, Bland R, Schwartz S, Hopkins JA. Pathogenesis of respiratory failure (ARDS) after hemorrhage and trauma, I: cardiorespiratory patterns preceding the development of ARDS . Crit Care Med . 1980;8: 504-512.Crossref 33. Shoemaker WC, Appel PL, Bishop MH. Temporal patterns of blood volume, hemodynamics, and oxygen transport in pathogenesis and therapy of postoperative adult respiratory distress syndrome . New Horiz . 1993;1:522-537. 34. Jardin F, Eveleigh MC, Gurdjian F, Delille F, Margairaz A. Comparative effects of blood volume expansion, dopamine infusion and isoproterenol infusion on mismatching of ventilation and pulmonary blood flow in peritonitis . Circulation . 1979; 60:155-159.Crossref 35. Barzotta AP, Polk HC. Multiple system organ failure . Surg Clin North Am . 1983; 63:315-336.

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 1, 1997

References

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