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Effects of Positive End-Expiratory Pressure and Crystalloid vs Colloid Fluid Resuscitation

Andrew B. Peitzman, MD; G. Tom Shires, III, MD; Hana Illner, MD; G. Tom Shires, MD

Arch Surg. 1982;117(5):662-668.

Abstract
• Pulmonary acid aspiration results in hypoxemia and hypovolemia. We assessed the effects of positive end-expiratory pressure (PEEP) and fluid resuscitation on oxygenation and alveolar-capillary membrane permeability after acid aspiration. Alveolar-capillary membrane permeability was assessed by determination of extravascular lung water volume, using the thermal-green dye double-indicator technique, extravasation of iodinated I 125 serum albumin into lung parenchyma, and albumin leak into the alveolar spaces. The data from this study demonstrated that PEEP improved oxygenation after acid aspiration, but did not alter progression of the injury; cardiac output and oxygen transport were improved by plasma volume repletion while receiving PEEP; and resuscitation with 5% albumin solution increased plasma albumin content and tracheal albumin content commensurately and did not modify progression of the injury.

(Arch Surg 1982;117:662-668)

Author Affiliations
From the Department of Surgery, The New York Hospital-Cornell Medical Center, New York. Dr Peitzman is now with the Department of Surgery, University of Pittsburgh School of Medicine.

Footnotes
Accepted for publication Dec 28, 1981.

Read before the 89th annual meeting of the Western Surgical Association, Albuquerque, Nov 17, 1981, and in part before the Clinical Congress of the American College of Surgeons, San Francisco, Oct 15, 1981.

Reprint requests to F-739, Department of Surgery, The New York Hospital-Cornell Medical Center, 525 E 68th St, New York, NY 10021 (Dr G. Tom Shires).

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