Colloid osmotic pressure during and after surgical interventions in adult and geriatric dogs / Pressão coloidosmótica durante e depois de intervenção cirúrgica em cães adultos e geriátricos

The objective this study is to evaluate colloid osmotic pressure (COP) fluctuations in adult and senile dogs during surgical interventions. Thirty-six healthy dogs to surgical interventions, distributed in two groups, A and B, according to their age, and were all subjected to the same anesthetic protocol. Values of albumin, total plasmatic protein and COP were evaluated from samples collected before pre-anesthetic medication, fifteen minutes after pre-anesthetic medication, and shortly after the end of the intervention. Results were tested using t-test to compare among groups and ANOVA for repeated measures followed by Tukey's test to compare different moments within the same group. Statistical significance was set at p<0.05. In both groups, significant decreases were observed in colloid osmotic pressure, as well as albumin and total proteins (p<0.001). Despite slightly lower COP values for the group of adult animals, this difference was not significant as there was a high individual variation within groups. The results therefore indicate no difference in colloid osmotic pressure values or fluctuation patterns among adult and senile dogs (p=0.124). The observed results indicate that colloid osmotic pressure decreases significantly during surgical procedures, due to hypotension caused by the anesthetic drugs and to hemodilution caused by the fluid administration but there is no difference between groups. However, in both adult and senile dogs, these variables recover gradually after the animals awaken, through increased urine production and recovery of vascular tonus, indicating the successful reestablishment of homeostasis.(AU)

O objetivo deste estudo é avaliar as flutuações da pressão coloidosmótica (PCO) em cães adultos e idosos durante a intervenção cirúrgica. Foram utilizados 36 cães hígidos submetidos à intervenção cirúrgica, distribuídos em dois grupos de acordo com a idade e submetidos ao mesmo protocolo anestésico. Os valores de albumina, proteína plasmática total e PCO foram avaliados de amostras coletadas antes da medicação pré-anestésica, 15 minutos após e ao final do procedimento cirúrgico. Os dados obtidos foram analisados através do teste-t para comparação entre os grupos e ANOVA para medidas repetidas seguido do teste de Tukey para comparar diferentes momentos dentro do mesmo grupo. Foram considerados estastisticamente diferentes com p<0.05. Em ambos os grupos foram observados decréscimo dos valores da pressão coloidosmótica, como os valores de albumina e proteína total (p<0.001). Apesar de ligeiramente inferior, os valores de PCO para o grupo adulto não apresentaram diferença significativa. Os resultados indicam que não houve diferença nos valores da pressão oncótica ou padrão de flutuação entre adultos e idosos (p=0,124). Os resultados observados indicam significativo decréscimo da pressão coloidosmótica durante os procedimentos cirúrgicos devido à hipotensão causada pelos fármacos anestésicos e pela hemodiluição causada pela administração de fluídos, mas não houve diferença entre os grupos. Entretanto, tanto em cães adultos como idosos, essas variações retornaram gradualmente após a recuperação dos animals, através do aumento da produção de urina e da recuperação do tônus vascular, indicando restabelecimento da homeostase.(AU)

Uso de albumina humana em pacientes graves: controvérsias e recomendações / Albumin in critically ill patients: controversies and recommendations

O uso de albumina humana como terapêutica nas unidades de terapia intensiva é tradicional há mais de 50 anos. No entanto, estudos no final dos anos 90 apontaram um possível malefício em relação ao seu uso em pacientes graves. O efeito da controvérsia causado por esta publicação perdurou mesmo após a publicação de outras meta-análises e estudos randomizados e controlados, que não encontraram relação de prejuízo para o uso desta solução coloide. No Brasil, vários serviços públicos e privados seguiram recomendações da Agência Nacional de Vigilância Sanitária sobre usos adequados ou não da albumina venosa. Nesta revisão, procuramos abordar as razões da administração de albumina, assim como reunir evidências metabólicas e imunomoduladoras de possíveis efeitos deste coloide no paciente grave. Os estudos de maior impacto desde 1998 até os dias atuais foram pormenorizados, demonstrando que não parece existir aumento de mortalidade com o uso de albumina venosa, em relação às soluções cristaloides. As indicações da Agência Nacional de Vigilância Sanitária foram discutidas diante das evidências atuais sobre o uso de albumina no doente crítico.

Human albumin has been used as a therapeutic agent in intensive care units for more than 50 years. However, clinical studies from the late 1990s described possible harmful effects in critically ill patients. These studies' controversial results followed other randomized controlled studies and meta-analyses that showed no harmful effects of this colloid solution. In Brazil, several public and private hospitals comply with the Agência Nacional de Vigilância Sanitária (the Brazilian Health Surveillance Agency) recommendations for appropriate administration of intravenous albumin. This review discusses indications for albumin administration in critically ill patients and analyzes the evidence for metabolic and immunomodulatory effects of this colloid solution. We also describe the most significant studies from 1998 to the present time; these reveal an absence of incremental mortality from intravenous albumin administration as compared to crystalloid solutions. The National Health Surveillance Agency indications are discussed relative to the current body of evidence for albumin use in critically ill patients.

Presión coloidosmótica plasmática, índice de Briones y ascitis en preeclampsia-eclampsia / Plasma colloid osmotic pressure, Briones index and ascites in preeclampsia-eclampsia

Introducción: La fuga capilar en la preeclampsia-eclampsia se puede evaluar calculando la presión coloidosmótica de las proteínas plasmáticas (PCO) y el índice de Briones. El objetivo de la presente investigación fue informar los valores de la PCO y del índice de Briones en preeclampsiaeclampsia, y comparar su correlación con ascitis. Material y métodos: Se estudiaron 225 pacientes gestantes con preeclampsia-eclampsia. Se calculó la PCO y el índice de Briones como grupo total y en tres categorías: a) preeclampsia severa sin síndrome HELLP, b) preeclampsia severa con síndrome HELLP y c) eclampsia. Se comparó la correlación de ambos parámetros entre sí y con la ascitis. Pruebas estadísticas: t de Student, coeficiente de correlación de Pearson (r). Resultados: La PCO total fue de 20.14 ± 2.52 mm Hg, en 148 casos (65.78 %) resultó normal (21.54 ± 1.60 mm Hg) y en 77 (34.22 %) fue baja (17.55 ± 1.71 mm Hg) (p = 0.058). No hubo diferencia entre las tres categorías (p > 0.05). El índice de Briones total fue de 0.18 ± 0.03, en 87 casos (38.67 %) resultó normal (0.22 ± 0.01) y en 138 (61.33 %) se encontró bajo (0.16 ± 0.01) (p = 0.07). No hubo diferencia entre las tres categorías (p > 0.05). Se documentó ascitis (627.27 ± 85.21 ml) en 11 pacientes (4.89 %). La r de la PCO versus índice de Briones fue de 0.55, PCO versus ascitis fue de −0.03 y del índice de Briones versus ascitis fue de −0.43. Conclusiones: Se encontraron valores bajos de la PCO en 34.22 % y del índice de Briones en 61.33 %. Ambos parámetros tuvieron correlación negativa con la ascitis.

BACKGROUND: Capillary leak in preeclampsia-eclampsia (P-E) can be evaluated by calculating the plasma colloid osmotic pressure (COP) and the Briones index (BI). We undertook this study to report the values of plasma COP and BI in patients with P-E. We compared their correlation with ascites. METHODS: We studied 225 pregnant patients with P-E. We calculated plasma COP and BI as a total group and in three categories: 1) severe preeclampsia (SP) patients without HELLP syndrome, 2) SP patients with HELLP syndrome and 3) patients with eclampsia. We compared the correlation of both parameters as well as the correlation of each with ascites. Student's t test and Pearson correlation coefficient (r) were used for statistical analysis. RESULTS: Total COP was 20.14 +/- 2.52 mmHg. In 148 cases (65.78%) the results were normal (21.54 +/- 1.60 mmHg) and in 77 cases (34.22%) results were low (17.55 +/- 1.71 mmHg) (p = 0.058). There was no difference among the three categories (p >0.05). Total BI was 0.18 +/- 0.03, in 87 cases (38.67 %) it was normal (0.22 + 0.01) and in 138 cases (61.33 %) it was low (0.16 +/- 0.01) (p = 0.07). There were no differences among the three categories (p >0.05). We documented ascites of 627.27 +/- 85.21 ml in 11 patients (4.89%). The r of the COP vs. BI was 0.55, COP vs. ascites was -0.03 and BI vs. ascites was -0.43. CONCLUSIONS: We found low levels of COP in 34.22% and BI in 61.33% of patients. Both parameters had negative correlation with ascites.

The change of plasma colloid osmotic pressure and blood coaglulation in percutaneous nephrolithotripsy during anesthesia / 中国基层医药

Objective To provide basis of preventing and treating complications by monitoring plasma colloid osmotic pressure and blood clotting function during anesthesia of percutaneous nephrolithotomy (PCNL).Methods 30 patients with upper urinary calculus were equally and randomly divided into two groups according to the different anesthesia method. In General anesthesia group, Midazolam 0. 1 mg/kg、diprivan 1.5mg/kg、Vecuronium bromide 0. 15mg/kg、fentanyl 4μg/kg were used to guide and forane 1 ～ 1.3MAC were used to keep inhalation anesthesia. In lumbar-epidural anesthesia group T12～12 or T12 ～ L1 epidural anesthesia with 0.75% ropivacaine 8 ～ 10 ml and L2～4 lumbar anesthesia with bupivacaine 10mg were used. Plasma colloid osnotic pressure, central venous pressure and TEG were detected at the beginning and at the end of operation and fluid consumption were compared between the two groups. Results There was no obvious difference between the two groups. In both groups ,COP was obviously reduced and CVP was improved after the operation which significantly different with those pre-operation ( all P <0. 01 ). R value reduced significantly(P <0. 05). There were 10 patients complicated with chilling, unconffortability,or anxiety. Conclusion During anesthesia of percutaneous nephrolithotomy, with operation time going on, COP reduced obviously, which increased the risk of heart failure, pulmonary edema, etc. but had no effect on blood clotting.

The importance of maintaining the colloid osmotic pressure in the critical patients / 中华急诊医学杂志

Objective To investigate the relationship between the colloid osmotic pressure (COP) as well asosmolality and the outcomes of critical patients. Method Totally 1568 critical patients were chosen from emergen-cy intensive care unit and surgical intensive care unit in Chaoyang Hospital Affiliated to Capital Medical Universityfrom January 2002 to December 2005, and divided into different groups according to levels of COP and osmolality.In group program Ⅰ, all patients were divided into 2 subgroups based on COP (the critical value was 20 mmHg =1.2 mOsm/kg H2O)on the day of admission. In group program Ⅱ, the same patients were divided into 3 sub-groups based on osmolality (the critical value was in the range from 280 mOsm/kg H2O aad 310 mOsm/kgH2O)which was also measured on the day of admission. The mortality of patients was calculated. Chi-square test wasused. Results Compared with patients of normal colloid osmotic pressure group, patients of lower colloid osmoticpressure group had higher mortality(24.5% vs. 17.7%, P = 0.001). Compared with the patients of normal os-molality group, the patients of lower total osmotic pressure group had lower mortality(17.0% vs. 24.5%, P =0.000). Conclusions Compared with the normal osmolality, the normal colloid osmotic pressure had the moreclosely relationship with the outcomes of critical patients, and it maybe a predictor of prognosis of the critical pa-tients.

Measurement of Colloid Osmotic Pressure in Pregnancy Induced Hypertensive Patients / 대한마취과학회지

BACKGROUND: Pregnancy induced hypertension (PIH) is a common cause of maternal morbidity and death in late pregnancy. Pulmonary edema, although infrequently encountered, may cause death in severe cases of PIH. However, the mechanisms that account for pulmonary edema have not been clarified. Mobilization of peripheral edema, excess fluid intake, myocardial dysfunction, and reduced plasma protein concentration are factors that have been postulated as contributing to the development of pulmonary edema in this syndrome. Colloid osmotic pressure is a principal regulator of capillary fluid exchange. METHODS: In a study of 50 normotensive and severe PIH patients who underwent cesarean section, peripartum plasma colloid osmotic pressure, serum albumin, and total serum protein were compared. RESULTS: Both groups exhibited significantly lower plasma colloid osmotic pressure in the postpartum period than that measured antepartum (p<0.05). The mean antepartum plasma colloid osmotic pressure in severe PIH patients was significantly lower than in normotensive subjects (p<0.05). CONCLUSIONS: We believe that serial COP measurments may be helpful to guide optimal fluid management in severe PIH patients.

Efeito da furosemida endovenosa sobre os parâmetros hemodinämicos e na pressäo coloidosmótica em pacientes com congestäo pulmonar / Intravenous Furosemide Effects Over Hemodynamics Variables and Colloid Osmotic Pressure in Patients with Pulmonary Edema

Objetivo - Avaliar o efeito da furosemida endovenosa sobre os parâmetros hemodinâmicos e na pressão coloidosmótica pulmonar em pacientes com congestão pulmonar. Métodos - Foram avaliados oito pacientes com congestão pulmonar, com idade média de 58,3 ±7,5, sendo 6 do sexo masculino. A monitorização hemodinâmica foi realizada com cateter de Swan-Ganz em artéria pulmonar obtendo-se as pressões médias de átrio direito (PAD), capilar pulmonar (PMCP), em mmHg, e freqüência cardíaca (FC) em bpm. O débito cardíaco (DC) obtido pela técnica da termodiluição. Como parâmetros derivados calculou-se o índice cardíaco (IC) em L/min/m2 e o índice sistólico (IS) em ml. A pressão arterial média (PAM), em mmHg, foi obtida através de cateter em artéria radial. Os pacientes foram tratados com furosemida na dose de 20 mg, via endovenosa, e submetidos a medidas hemodinâmicas antes e após 5, 15, 30, 60 e 120 min. A pressão coloidosmótica pulmonar (PCOP) foi determinada pelo oncômetro de Weil (IL 196). Resultados - Observou-se redução estatisticamente significante das PAD (p = 0,002 e da PMCP (p < 0,0001), FC (p = 0,02), PCOP (p < 0,0001) e de gradiente entre a PMCP-PCOP (p < 0,0001). A queda da PAD e PMCP foram mais significativas nos primeiros 5 minutos e, ao contrário, a PCOP teve uma redução lenta e gradual nos 120 min. O gradiente entre a PMCP-PCOP, inicialmente positivo, permaneceu negativo durante todo o estudo. A PAM, IC, IS e RVS não apresentaram diferenças estatisticamente significantes. Conclusão - A administração de furosemida produz redução nas PAD, PMCP, FC, PCOP e do gradiente entre a PMCP-PCOP, provavelmente devido a redistribuição do excesso de líquidos do interstício para o intravascular e, devido ao predomínio da PCOP, ocorre a reinversão da direção do fluxo de líquidos, que durante o edema pulmonar era do intravascular para o interstício

Purpose - To evaluate the effects of intravenous furosemide over hemodynamics variables and colloid osmotic pressure in patients with pulmonary edema. Methods - Eight patients with pulmonary edema, mean age of 58.3 ± 7.5 years, 6 men, were evaluated. Hemodynamic monitorization was performed by Swan-Ganz catheter in pulmonary artery to obtain RAP and PAWP, in mmHg, and HR, in bpm. Cardiac ouput (CO) was obtained by termodilution method. Cardiac index (CI) in L/min/m2, and systolic index, in ml, arised from variables above. Mean arterial pressure (MAP), in mmHg, patients were treated with 20 mg of intravenous furosemide, and hemodynamic variables were measured before and after 5, 15, 30, 60 and 120 minutes. COP was measured in Weil oncometer (IL 196) at same intervals. Results - A significant reduction of RAP (p=0,002) and PAWP (p<0,0001), HR (p=0,02), COP (p<0,0001) and gradient between PAWPCOP (p<0,0001) were observed. RAP and PAWP reduction was greater in the first five minutes and, otherwise, COP reduction was gradual in 120 min. PAWP-COP gradient inicially positive, stayed negative during all study. MAP, CI, SI and SVR did not show statistical differences. Conclusion - Furosemide administration reduced RAP, PAWP, HR, COP and PAWP-COP gradient, probably by a redistribuition offluid excess in the intersticial to intravascular space, through changes in driving fluid forces, with predominance in colloid osmotic pressure, which reverse fluid from intravascular to intersticial observed in pulmonary edema.

The Change of Colloid Osmotic Pressure during Pediatric Open Heart Surgery / 대한마취과학회지

To evaluate the change of colloid osmotic pressure(COP) and the correlation between COP and other parameters during pediatric open heart surgery at Seoul National University Children's Hospital, COP, protein, albumin, hemoglobin, and hematocrit, were measured immediately after induction(T1), before cardiopulmonary bypass(CPB)(T3), duringT4, T5), and after bypass(T.6, T7) and immediately after(T8) and 24 hour after(T9) arrival at intensive care unit (ICU) in l0 pediatric patients aged from l year to 13 years. Above parameters of priming solution(T2) were also measured. The results were as followings; l) The good correlation between COP and protein(r=0.87), albumin(r=0.86), hemoglobin(r=0. 80), hematocrit(r=0.77) were showed. 2) The COP of priming solution was 9.42.6 mmHg and this was definitely lower than normal value. 3) The COP during CPB was in the range from 11 to 12 mmHg(mean values) and this value was also significantly lower than normal value. 4) The COP increased from the time of weaning from CPB, but the COP at the arrival at ICU was 18.0+/-1.2 mmHg and this value was still significantly lower than normal value. 5) The COP at 24 hours after arrival at ICU was 21.7+/-1.2 mmHg and this value was not significantly different fron normal value. Thus, the results suggest that the priming solution shuold be improved to maintain COP during and immediatelt after CPB.