FLUID RESUSCITATION FOR HYPOTENSION AND THE PRODUCTION OF PULMONARY EDEMA

Abstract

The choice of fluid replacement for treatment of neonatal hypotension remains controversial. Recent reports have suggested 10% albumin should not be used because it may cause intracranial hemorrhage or pulmonary edema. We have studied this problem further in 26 conscious lambs, 2-5 days old, acutely surgically prepared with femoral and aortic catheters. 25% of circulating blood volume was rapidly exsanguinated (Exs) (10 minutes). The animals were then randomly given no albumin or therapy (Tx) of 1 g/Kg of 5 or 10% albumin. Vital signs were continuously recorded. Acid-base status and hct were determined hourly. The arterial/alveolar PO2 ratio (PaO2/PAO2) was used as the clinical index of pulmonary edema.Following therapy, the untreated animals remained hypotensive and 3 died. The animals given 10% albumin developed pulmonary edema as evidenced by the significant fall in PaO2/PAO2 ratio (p < .01).We conclude that while albumin restores Bp in the hypotensive lamb it also produces significant pulmonary edema.