Treatment of canine aspiration pneumonitis: Fluid volume reduction vs. fluid volume expansion

Long, Richard C.; Breen, Peter H.; Mayers, Irvin

doi:10.1016/0883-9441(89)90063-4

Cited by 4 publications

(6 citation statements)

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“…In addition to the iatrogenic volume overload that may occur with treatment of the initial systemic insult (particularly sepsis), positive pressure ventilation decreases ventricular preload and also causes increases in endogenous levels of antidiuretic hormone, renin, aldosterone, and angiotensin II, all of which predispose to volume overload. [14][15][16] Early animal models of ARDS suggested that reducing intravascular volume reduced the amount of pulmonary edema, [17][18][19][20][21][22] but it remained unclear if reducing edema would improve clinical outcomes. Furthermore, most patients with ARDS do not die from hypoxemia, but from multiorgan system failure.…”

mentioning

confidence: 99%

Fluid Management in Acute Respiratory Distress Syndrome

Casey

Semler

Rice

2019

Semin Respir Crit Care Med

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One of the defining features of acute respiratory distress syndrome (ARDS) is noncardiogenic pulmonary edema, resulting from increased permeability of the alveolar–capillary barrier and passage of protein-rich fluid into the interstitium and alveolar spaces. The loss of protein from the intravascular space disrupts the normal oncotic pressure differential and causes patients with ARDS to be particularly sensitive to the hydrostatic forces that correlate with intravascular volume. Conservative fluid management, in which diuretics are administered and intravenous fluid administration is minimized, may decrease hydrostatic pressure and increase serum oncotic pressure, potentially limiting the development of pulmonary edema. However, the cause of death in most patients with ARDS is multiorgan system failure, not hypoxemia, and the impact of conservative fluid management on the incidence of extrapulmonary organ failure during ARDS is unclear. These physiologic observations have led to a series of studies examining the impact of fluid management on the development of, resolution of, survival from, and long-term outcomes from ARDS. While questions remain, the current literature makes it clear that fluid management is an integral part of the care of patients with ARDS.

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confidence: 99%

Fluid Management in Acute Respiratory Distress Syndrome

Casey

Semler

Rice

2019

Semin Respir Crit Care Med

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“…Among these are symptomatic measures, like management of fluid balance, and more recent therapeutic options, like inhalation of NO (2,4,8,11,12,17,18,28,35). These are both important since, apart from treatment of the underlying disease, there is no causal therapeutic approach (20,22,25,37,43). However, it still has to be evaluated in further studies wether a differentiated therapeutic strategy which might result from radioisotope albumin flux measurement can improve the outcome in patients with acute respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Radioisotope albumin flux measurement of microvascular lung permeability: an independent parameter in acute respiratory failure?

Hoegerle¹,

Benzing²,

Nitzsche³

et al. 2001

Nuklearmedizin

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Summary Aim: To evaluate the extent to which single measurements of microvascular lung permeability may be relevant as an additional parameter in a heterogenous clinical patient collective with Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). Methods: In 36 patients with pneumonia (13), non pneumogenic sepsis (9) or trauma (14) meeting the consensus conference criteria of ALI or ARDS double-isotope protein flux measurements (51Cr erythrocytes as intravascular tracer, Tc-99m human albumin as diffusible tracer) of microvascular lung permeability were performed using the Normalized Slope Index (NSI). The examination was to determine whether there is a relationship between the clinical diagnosis of ALI/ARDS, impaired permeability and clinical parameters, that is the underlying disease, oxygenation, duration of mechanical ventilation and mean pulmonary-artery pressure (PAP). Results: At the time of study, 25 patients presented with increased permeability (NSI > 1 × 10-3 min1) indicating an exudative stage of disease, and 11 patients with normal permeability. The permeability impairment correlated with the underlying disease (p >0.05). With respect to survival, there was a negative correlation to PAP (p <0.01). Apart from that no correlations between the individual parameters were found. Especially no correlation was found between permeability impairment and oxygenation, duration of disease or PAP. Conclusion: In ALI and ARDS, pulmonary capillary permeability is a diagnostic parameter which is independent from clinical variables. Permeability measurement makes a stage classification (exudative versus non exudative phase) of ALI/ARDS possible based on a measurable pathophysiological correlate.

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“…The theoretical sensitivity of the lung to hydro static stress when membrane permeability is abnor mal has been demonstrated experimentally in nu merous acute lung injury models. [20][21][22][23][24][25][26][27][28][29][30][31][32] For instance, after oleic acid administration, Prewitt et al 20 showed that decreasing left atrial pressures by only 4 mm Hg (either by controlled hemorrhage or nitroprusside) resulted in a 25 to 32% reduction in EVLW accumulation during the first 4 hours of in jury. Likewise, using an in situ, perfused, dog lung preparation, Huchon et al 21 showed that signifi cantly more edema accumulated after the same dose of injurious agent in animals maintained with "high" left atrial pressures ( ~ 18 mm Hg) than in those animals with pressures kept at 0 mm Hg.…”

Section: Experimental Rationalementioning

confidence: 99%

“…3), are associated with increased EVLW, even when pulmonary artery occlusion pressure (i.e., left atrial pressure) is kept constant. [43][44][45] All of these experimental studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33][38][39][40][41][42][43][44][45] lead to the conclusion that reduced capillary pressures and/or reduced perfusion to acutely injured lung units result in reduced EVLW accumulation.…”

Section: Experimental Rationalementioning

confidence: 99%