Fluid therapy

Following lung resection pulmonary artery pressure rises, there is an increase in right ventricular stroke work, and an increased risk of developing pulmonary edema. For these reasons post-pneumonectomy patients are often fluid restricted. This policy stems from the mistaken belief that pulmonary edema following lung resection is mainly related to circulating volume. However, such action fails to take into account the principal difference between classical pulmonary edema, which is pressure related (high pulmonary artery wedge pressure), and post-pneumonectomy edema, which is flow related (pulmonary artery wedge pressure normal or low). Post-pneumonectomy patients, whilst not needing to be excessively transfused, do need a sufficiently high right ventricular filling pressure to maintain cardiac output and organ perfusion. Plasma oncotic pressure should be maintained. Attempts to produce hyperosmolar states by protein infusion or the use of diuretics are distinctly unhelpful and are often used without good evidence of any benefit. The former may induce true left ventricular failure, whilst the latter may result in a reduced cardiac output and hypotension.

There is concern regarding the potential combination of relative dehydration and non-steroidal analgesia which is potentially disastrous for renal function, particularly in patients with limited reserve.

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