Large Volume Crystalloid Resuscitation Does Not Increase Extravascular Lung Water

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Abstract
The purpose of this study was to determine whether Ringer's lactate solution increases extravascular lung water (EVLW) during resuscitation after hemorrhagic shock. Ten sheep anesthetized with thiamylal were bled to a mean arterial pressure (MAP) of 50 mm Hg; further bleeding maintained that pressure for 30 min. Resuscitation fluid consisted of Ringer's lactate solution in volumes necessary to restore and maintain for 1 hr MAP, pulmonary capillary wedge pressure (PCWP), and cardiac index at levels equal to those measured before bleeding. After volume replacement, the colloid oncotic pressure (COP) - PCWP gradient (COP - PCWP) decreased from 12 ± 3 to 2 ± 5 mm Hg (P < 0.001). After volume restoration, COP decreased from 19 ± 8 mm Hg to 12 ± 2 mm Hg (P < 0.001). Despite the large volume of fluid administered, EVLW did not increase. Crystalloid resuscitation does not necessarily increase EVLW despite significant decreases in COP and COP - PCWP gradient.

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