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Alan T. Marty, MD; Alfonso M. Miyamoto, MD; Max H. Weil, MD; Peter A. Philips, MD

AMA Arch Surg. 1974;109(1):61-64.

Abstract
Low plasma oncotic pressure (COP) following dilutional cardiopulmonary bypass (DCB) may lead to pulmonary edema. As it is difficult to normalize postbypass COP with concentrated albumin therapy, which itself causes pulmonary dysfunction, another method of hastening postbypass COP normalization was examined. Alveolar-arterial oxygen pressure gradients (A-aDO)₂ of 12 patients in whom hypothermically induced, complete COP normalization was achieved within 90 minutes of DCB were compared with a previously reported normothermic, albumin-treated group in whom A-aDO₂ worsened by 104 ± 22 mm Hg (P<.01). No worsening of postbypass A-aDO₂ occurred in the hypothermic group. Furthermore, transthoracic impedance fell 7.9 ohms after DCB, suggesting that a rise in pulmonary water content need not widen A-aDO₂ after DCB. Why hypothermia hastens postbypass oncotic normalization is uncertain. Possible mechanisms include postbypass "cold diuresis," water shifts out of the blood, or intravascular translocation of interstitial protein.

Author Affiliations
Los Angeles; Duarte, Calif; Los Angeles; Duarte, Calif

From the departments of thoracic and cardiovascular surgery, City of Hope National Medical Center, Duarte, Calif (Drs. Marty, Miyamoto, and Philips), Cedars of Lebanon Hospital, Los Angeles (Dr. Marty), and Critical Care Center, Hollywood Presbyterian Hospital and University of Southern California, Los Angeles (Dr. Weil).

Footnotes
Accepted for publication Feb 18, 1974.

Read before the annual meeting of the Southern California Chapter of the American College of Surgeons, Palm Springs, Calif, Jan 19, 1974.

Reprint requests to City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010 (Dr. Marty).

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