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Perfusion
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The influence of vascular pressure and different primes on the fluid balance of, and oxygen supply to, the patient during CABG

JA Sirs

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

B. Glenville

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

RL Stanbridge

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

F. Sogliani

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

G. Stavrides

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

AW Harrop Griffiths

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

J. Jones

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

K. Macleod

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

A. Akins

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

J. Powell

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

S. Davis

Department of Cardiothoracic Surgery and Department of Anaesthetics, St Mary's Hospital, London

Detrimental changes of blood and erythrocyte rheology, and fluid exchange between the vascular and interstitial spaces, which influence the rate that oxygen is supplied to the patient, occur during cardiac bypass surgery. Venous flow is subject to a pulsatile and uncertain variation, because the vena cava is more than 30 mmHg below atmospheric pressure. This occurs because the patient is about 1 m above the air-blood surface of the bypass reservoir. Before any reliable study of fluid exchange can be undertaken this effect must be controlled. It was then established that optimum oxygen exchange occurs when equilibration of the plasma oncotic pressure and the capillary hydrostatic pressure is achieved without alteration of the interstitial fluid volume. At the lower arterial blood pressures used during bypass, it is necessary to reduce the plasma oncotic pressure by using an appropriate volume of crystalloid prime.

Perfusion, Vol. 10, No. 1, 33-44 (1995)
DOI: 10.1177/026765919501000107
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