Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1983 Jul;198(1):96–101. doi: 10.1097/00000658-198307000-00019

The effects of hemodilution during pulmonary edema in dogs.

M J Bishop, F W Cheney
PMCID: PMC1352940  PMID: 6859999

Abstract

Because of their multiple medical problems, patients with the adult respiratory distress syndrome (ARDS) often develop anemia. In order to determine the effects of a low hemoglobin concentration on gas exchange in such patients, the authors studied the effects of isovolemic hemodilution in the dog oleic acid model of ARDS. Twelve splenectomized dogs with oleic acid-induced pulmonary edema and a consequent venous admixture of 31% +/- 5% (mean +/- SEM) (FIO2 = 0.21) underwent two-stage isovolemic hemodilution with Hetastarch followed by retransfusion of the withdrawn red cells. This resulted in hemoglobin levels at each stage of 12.7 +/- 0.7 g/100 ml, 9.1 +/- 0.6 g/100 ml, 6.5 +/- 0.5 g/100 ml, and 10.1 +/- 0.5 g/100 ml (mean +/- SEM). Oxygen transport fell from 363 +/- 25 ml/kg/min to 219 +/- 17 ml/kg/min (p less than 0.001) at maximum hemodilution during air ventilation and from 383 +/- 79 ml/kg/min to 292 +/- 91 ml/kg/min (p less than 0.001) during oxygen ventilation. Since oxygen consumption remained constant throughout the hemoglobin range studied, decreased hemoglobin resulted in declines in P-VO2. Hemodilution with Hetastarch did not affect intrapulmonary shunt or venous admixture despite the significant increase in cardiac output associated with hemodilution.

Full text

PDF
96

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brazier J., Cooper N., Buckberg G. The adequacy of subendocardial oxygen delivery: the interaction of determinants of flow, arterial oxygen content and myocardial oxygen need. Circulation. 1974 May;49(5):968–977. doi: 10.1161/01.cir.49.5.968. [DOI] [PubMed] [Google Scholar]
  2. Brazier J., Cooper N., Maloney J. V., Jr, Buckberg G. The adequacy of myocardial oxygen delivery in acute normovolemic anemia. Surgery. 1974 Apr;75(4):508–516. [PubMed] [Google Scholar]
  3. Brazier J., Cooper N., Maloney J. V., Jr, Buckberg G. The adequacy of myocardial oxygen delivery in acute normovolemic anemia. Surgery. 1974 Apr;75(4):508–516. [PubMed] [Google Scholar]
  4. Cain S. M., Chapler C. K. O2 extraction by hind limb versus whole dog during anemic hypoxia. J Appl Physiol Respir Environ Exerc Physiol. 1978 Dec;45(6):966–970. doi: 10.1152/jappl.1978.45.6.966. [DOI] [PubMed] [Google Scholar]
  5. Cain S. M. Oxygen delivery and uptake in dogs during anemic and hypoxic hypoxia. J Appl Physiol Respir Environ Exerc Physiol. 1977 Feb;42(2):228–234. doi: 10.1152/jappl.1977.42.2.228. [DOI] [PubMed] [Google Scholar]
  6. Cheney F. W., Colley P. S. The effect of cardiac output on arterial blood oxygenation. Anesthesiology. 1980 Jun;52(6):496–503. doi: 10.1097/00000542-198006000-00009. [DOI] [PubMed] [Google Scholar]
  7. Danek S. J., Lynch J. P., Weg J. G., Dantzker D. R. The dependence of oxygen uptake on oxygen delivery in the adult respiratory distress syndrome. Am Rev Respir Dis. 1980 Sep;122(3):387–395. doi: 10.1164/arrd.1980.122.3.387. [DOI] [PubMed] [Google Scholar]
  8. Escobar E., Jones N. L., Rapaport E., Murray J. F. Ventricular performance in acute normovolemic anemia and effects of beta blockade. Am J Physiol. 1966 Oct;211(4):877–884. doi: 10.1152/ajplegacy.1966.211.4.877. [DOI] [PubMed] [Google Scholar]
  9. Fowler N. O., Holmes J. C. Blood viscosity and cardiac output in acute experimental anemia. J Appl Physiol. 1975 Sep;39(3):453–456. doi: 10.1152/jappl.1975.39.3.453. [DOI] [PubMed] [Google Scholar]
  10. Laks H., Pilon R. N., Anderson W., McCallum J. R., O'Connor N. E. Intraoperative prebleeding in man: effect of colloid hemodilution on blood volume, lung water, hemodynamics, and oxygen transport. Surgery. 1975 Aug;78(2):130–137. [PubMed] [Google Scholar]
  11. Laks J., Pilon R. N., Klovekorn W. P., Anderson W., MacCallum J. R., O'Connor N. E. Acute hemodilution: its effect of hemodynamics and oxygen transport in anesthetized man. Ann Surg. 1974 Jul;180(1):103–109. doi: 10.1097/00000658-197407000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lazrove S., Waxman K., Shippy C., Shoemaker W. C. Hemodynamic, blood volume, and oxygen transport responses to albumin and hydroxyethyl starch infusions in critically ill postoperative patients. Crit Care Med. 1980 May;8(5):302–306. doi: 10.1097/00003246-198005000-00007. [DOI] [PubMed] [Google Scholar]
  13. LeVeen H. H., Ip M., Ahmed N., Mascardo T., Guinto R. B., Falk G., D'Ovidio N. Lowering blood viscosity to overcome vascular resistance. Surg Gynecol Obstet. 1980 Feb;150(2):139–149. [PubMed] [Google Scholar]
  14. Lynch J. P., Mhyre J. G., Dantzker D. R. Influence of cardiac output on intrapulmonary shunt. J Appl Physiol Respir Environ Exerc Physiol. 1979 Feb;46(2):315–321. doi: 10.1152/jappl.1979.46.2.315. [DOI] [PubMed] [Google Scholar]
  15. MURRAY J. F., GOLD P., JOHNSON B. L., Jr Systemic oxygen transport in induced normovolemic anemia and polycythemia. Am J Physiol. 1962 Oct;203:720–724. doi: 10.1152/ajplegacy.1962.203.4.720. [DOI] [PubMed] [Google Scholar]
  16. Malmberg P. O., Woodson R. D. Effect of anemia on oxygen transport in hemorrhagic shock. J Appl Physiol Respir Environ Exerc Physiol. 1979 Oct;47(4):882–888. doi: 10.1152/jappl.1979.47.4.882. [DOI] [PubMed] [Google Scholar]
  17. Messmer K., Lewis D. H., Sunder-Plassmann L., Klövekorn W. P., Mendler N., Holper K. Acute normovolemic hemodilution. Changes of central hemodynamics and microcirculatory flow in skeletal muscle. Eur Surg Res. 1972;4(1):55–70. doi: 10.1159/000127600. [DOI] [PubMed] [Google Scholar]
  18. Michalski A. H., Lowenstein E., Austen W. G., Buckley M. J., Laver M. B. Patterns of oxygenation and cardiovascular adjustment of acute, transient normovolemic anemia. Ann Surg. 1968 Dec;168(6):946–956. doi: 10.1097/00000658-196812000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Murray J. F., Escobar E. Circulatory effects of blood viscosity: comparison of methemoglobinemia and anemia. J Appl Physiol. 1968 Nov;25(5):594–599. doi: 10.1152/jappl.1968.25.5.594. [DOI] [PubMed] [Google Scholar]
  20. Murray J. F., Rapaport E. Coronary blood flow and myocardial metabolism in acute experimental anaemia. Cardiovasc Res. 1972 Jul;6(4):360–367. doi: 10.1093/cvr/6.4.360. [DOI] [PubMed] [Google Scholar]
  21. Rose D., Coutsoftides T. Intraoperative normovolemic hemodilution. J Surg Res. 1981 Nov;31(5):375–381. doi: 10.1016/0022-4804(81)90077-9. [DOI] [PubMed] [Google Scholar]
  22. Ruiz B. C., Tucker W. K., Kirby R. R. A program for calculation of intrapulmonary shunts, blood-gas and acid-base values with a programmable calculator. Anesthesiology. 1975 Jan;42(1):88–95. doi: 10.1097/00000542-197501000-00013. [DOI] [PubMed] [Google Scholar]
  23. Shoukas A. A., MacAnespie C. L., Brunner M. J., Watermeier L. The importance of the spleen in blood volume shifts of the systemic vascular bed caused by the carotid sinus baroreceptor reflex in the dog. Circ Res. 1981 Sep;49(3):759–766. doi: 10.1161/01.res.49.3.759. [DOI] [PubMed] [Google Scholar]
  24. Smith G., Cheney F. W., Jr, Winter P. M. The effect of change in cardiac output on intrapulmonary shunting. Br J Anaesth. 1974 May;46(5):337–342. doi: 10.1093/bja/46.5.337. [DOI] [PubMed] [Google Scholar]
  25. Tyson K. R., Fender H. R. Direct influence of blood viscosity on pulmonary vascular resistance. J Pediatr Surg. 1975 Oct;10(5):779–783. doi: 10.1016/0022-3468(75)90384-x. [DOI] [PubMed] [Google Scholar]
  26. Wallenstein S., Zucker C. L., Fleiss J. L. Some statistical methods useful in circulation research. Circ Res. 1980 Jul;47(1):1–9. doi: 10.1161/01.res.47.1.1. [DOI] [PubMed] [Google Scholar]
  27. West J. B. Ventilation-perfusion inequality and overall gas exchange in computer models of the lung. Respir Physiol. 1969 Jun;7(1):88–110. doi: 10.1016/0034-5687(69)90071-1. [DOI] [PubMed] [Google Scholar]
  28. von Restorff W., Höfling B., Holtz J., Bassenge E. Effect of increased blood fluidity through hemodilution on coronary circulation at rest and during exercise in dogs. Pflugers Arch. 1975;357(1-2):15–24. doi: 10.1007/BF00584541. [DOI] [PubMed] [Google Scholar]
  29. von Restorff W., Höfling B., Holtz J., Bassenge E. Effect of increased blood fluidity through hemodilution on general circulation at rest and during exercise in dogs. Pflugers Arch. 1975;357(1-2):25–34. doi: 10.1007/BF00584542. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES