Measurement Of Colloid Osmotic Pressure Research Articles

Development of new colloid osmotic pressure measurement method using ultrafiltration membrane during cardiopulmonary bypass

Background: Clinical practice of measuring colloid osmotic pressure (COP) was abandoned after correcting hypoosmolarity did not improve overall patient outcomes. However, the use of albumin and colloidal solutions has contributed to maintaining intraoperative and postoperative fluid balance at lower levels. Reduced perioperative fluid balance is consistently reported to have positive effects on clinical outcomes. Priming solutions for cardiopulmonary bypass typically include colloids; however, the optimal type of priming solution has not yet been determined. Stricter COP management may further improve postoperative courses. To achieve this, the widespread adoption of a measurement method suitable for COP monitoring during cardiopulmonary bypass is required. Methods: A test circuit was made which measured COP using an ultrafiltration membrane method based on the changes in hydrostatic pressure that occurs across a semipermeable membrane. We then compared the measurements obtained using this method with colloidal osmometer measurements. Results: COP measurements were obtained for a total of 100 tests (10 times each for 10 test solutions). The evaluation parameters included simultaneous reproducibility, correlation with the colloid osmometer, and measurement time. The results demonstrated high accuracy of the ultrafiltration membrane method, simultaneous reproducibility within 3%, a high positive correlation with the colloid osmometer (correlation coefficient: R2 = 0.99; p < 0.01), and equal time required for measurement. Conclusion: Measuring COP using ultrafiltration membranes solves problems within existing measurement methods. Although further improvements in the method are necessary, it has implications for future research and clinical applications.

Colloid osmotic pressure and extravasation of plasma proteins following infusion of Ringer's acetate and hydroxyethyl starch 130/0.4.

During fluid infusion therapy, plasma proteins are diluted and leak from the intravascular space, which alters the colloid osmotic pressure (COP) and potentially affects coagulation. We hypothesised that acetated Ringer's and starch solution, alone or in combination, influence these mechanisms differently. On different occasions, 10 male volunteers were infused with 20ml/kg acetated Ringer's and 10ml/kg 6% hyroxyethyl starch 130/0.4 (Voluven(®) ) alone or in combination (first with starch solution followed by Ringer's solution). Blood samples were collected every 30-min for measurements of COP, blood haemoglobin, platelets, and plasma concentrations of albumin, immunoglobulins (IgG and IgM), coagulation factor VII (FVII), fibrinogen, cystatin C, activated partial thromboplastin time (APTT) and prothrombin international normalised ratio (PT-INR). Changes were compared with the haemoglobin-derived plasma dilution. The COP increased by 8.4% (SD 3) with starch and decreased by 26.2% (7.9) with Ringer's. These infusions diluted the plasma by 23.4% (5.3) and 18.7% (4.9) respectively. The COP changes in the combined experiment followed the same pattern as the individual infusions. Albumin and IgG changes in excess of the plasma dilution were very subtle. The intravascular contents of the IgM and platelets decreased, whereas FVII, fibrinogen and cystatin C increased. PT-INR increased by 1/3 of the plasma dilution, whereas changes in APTT did not correlate with the plasma dilution. The starch increased COP and only minor capillary leak occurred in healthy volunteers. The fluid-induced plasma dilution correlated with mild impairment of the extrinsic coagulation pathway but not of the intrinsic pathway.

Sera from early-onset, severely preeclamptic women directly modulate HLA-E expression in the EA.hy296 endothelial cell line

The expression of endothelial HLA-E in the context of the systemic inflammatory response observed in preeclampsia has not been established. An experimental study was designed to determine the effect of the sera of pregnant women on the expression of HLA-E in EA.hy296 endothelial cells. First, measurements of protein fractions were performed in sera from early-onset, severely preeclamptic women without HELLP syndrome, in which there was no significant difference in total proteins between the groups, but a reduced level of plasma albumin and an increase in α1-globulin were observed in both groups of pregnant women compared with non-pregnant women. Measurements of colloid osmotic pressure (COP) using a recalculated albumin/globulin ratio formula determined only a significant decrease in COP in all pregnant groups compared with non-pregnant women. The expression of membrane HLA-E was increased in EA.hy296 endothelial cells stimulated with sera of early-onset, severely preeclamptic women, while recombinant interferon-γ (IFN-γ) significantly reduced the expression of membrane HLA-E. Pro-inflammatory cytokines were measured by Luminex in the serum samples, and increased levels of tumor necrosis factor (TNF) and decreased levels of IFN-γ were observed in early-onset, severe preeclampsia compared with normal pregnancy. Moreover, soluble HLA-E was detected in these serum samples by Western blot and ELISA, but no significant difference was found. This raises the possibility that a systemic inflammatory response promotes a compensatory mechanism of COP balance in severe preeclampsia by release of inflammation-induced factors, including endothelial HLA-E. Evidence is now provided regarding HLA-E expression by EA.hy296 cells.

Significance of Measurement for Colloid Osmotic Pressure during Hemodialysis

Background and Purpose: Colloid osmotic pressure (COP) in plasma rises by ultrafiltration during hemodialysis, and it consequently causes plasma refilling in which water moves from interstitial tissue to capillary space. Although hemodynamic stability is one of the important factors for good dialysis outcome, no informative and convenient indicators are available other than monitoring of blood pressure. Thus, we measured COP during hemodialysis whether COP can be used as an indicator for the hemodynamic status in comparison with hematocrit (Ht). Plasma osmolality, ultrafiltration volume, and the alteration of blood pressure were also measured to examine whether COP is associated with them.Method: Sixteen patients hospitalized in this hospital were examined. Amongst them, 10 patients underwent both dialysis and ultrafiltration, while 4 patients received only dialysis and 2 patients were with ultrafiltration only by extracorporeal ultrafiltration method. Ultrafiltration was performed with constant speed to the dry weight for 4 h. The measurements of COP, plasma osmolality, Ht levels, and blood pressure were performed at 30 min (12.5% of the total water removal), 1 h (25%), 2 h (50%), and 3 h (75%) after the start of hemodialysis and also at the end of dialysis (100%).Result: COP markedly rose by 26.0% (±13.3%) in the patients who received both dialysis and ultrafiltration, whereas Ht rose by only 13.6% (±5.21%). And the curve for COP increase was sigmoid shape, whereas that for Ht showed linear change. On the other hand, in the patients whose Ht levels showed low values, the curves for both COP and Ht showed similar pattern.Conclusion: These results suggest that COP is a more sensitive indicator to be monitored for the hemodynamic status than Ht during hemodialysis.

Changes in circulating blood and plasma volume after hemoglobin-based oxygen carrier infusion and additional infusion of colloid solutions.

The aim of this study was to investigate the changes in circulating blood volume (CBV) after infusions of Hemoglobin glutamer-200 (bovine; Hb-200) in combination with 6% hetastarch in an animal model of acute posthemorrhagic anemia. Fifteen rabbits with a mean body weight of 2.2 +/- 0.2 kg were studied. After determination of the circulating plasma volume (CPV) and CBV, one third of the CBV was withdrawn via an arterial catheter. An equal volume of Hb-200 was then infused in the 5 animals in study group 1. In the remaining 10 animals, the same volume of 6% hetastarch solution was infused. Fifteen minutes after completion of the infusion, an additional infusion of 6% hetastarch at a dose equal to one third of the baseline CBV was performed in study group 1 and the control group. In study group 2, equal volumes of Hb-200 were infused. CPV measurements were performed at baseline, after hemorrhage, 5 and 15 minutes after volume replacement, and 1 and 15 minutes after hypervolemic hemodilution using the Evans blue dye dilution technique. The mean baseline CPV value was 53.4 +/- 1.1 mL/kg. The mean CBV at baseline was 90.8 +/- 4.9 mL/kg. After one third of the CBV was withdrawn, no differences in CBV or CPV were observed between the three groups. Replacement of one third of the CBV with Hb-200 significantly increased the CPV (73.7 +/- 1.8 mL/kg) when compared with the baseline level (53.5 +/- 1.8 mL/kg; n = 5; P < 0.05). The difference between the groups was first observed 15 minutes after infusion. CPV was significantly higher in study group 1 (87.0 +/- 2.2 mL/kg) compared with the other groups (80.2 +/- 2.6 mL/kg in the control group and 79.5 +/- 3.6 mL/kg in study group 2). After a second transfusion, the differences between the groups became more prominent. Study group 2 demonstrated the highest CPV and CBV. The two study groups demonstrated a statistically significant increase in circulating volumes compared with the control group. The magnitude of this difference was lower than expected based on in vitro colloid osmotic pressure measurements.

Colloid Osmotic Pressure of Parenteral Nutrition Components and Intravenous Fluids

AbstractObjective:Parenteral nutrition is an important part of therapy for critically ill animals that cannot tolerate enteral feedings. It has been hypothesized that parenteral nutrition might also play a role in increasing colloid osmotic pressure (COP). The purpose of this study was to measure COP of various parenteral nutrition components and compare them to the COP of commonly used intravenous solutions.Design:Membrane colloid osmometry was used to measure the COP of parenteral nutrition components (lipids, Abstractamino acids, dextrose solutions) and of synthetic colloids, crystalloids, and blood products.Main Results:Parenteral nutrition components and all crystalloid solutions had COP measurements &lt; 1 mm Hg. Great variation in COP was found in the different artificial colloids and blood products. The COP of the artificial colloids tested ranged from 32.7 ± 0.2 mm Hg for hetastarch to 61.7 ± 0.5 mm Hg for dextran 70.Conclusions:The results of this in vitro study suggest that parenteral nutrition does not directly contribute to an increase in oncotic pressure. Further studies are needed to determine whether parenteral nutrition may indirectly influence COP in vivo. Knowing the COP of a fluid, along with its other properties, is useful in making appropriate therapeutic decisions.

Nephrotic edema.

This article starts with a concise synopsis of the history of edema. The role of underfilling, overflow, antidiuretic hormone, and acquaporins is subsequently discussed. Emphasis is given to the use of diuretics in edematous patients. The role and risks of albumin infusion are illustrated. The new hypothesis of pulse reverse osmosis is discussed. The final section deals with the measurement of colloid osmotic pressure in the clinical setting.

Correlation Between Increased Colloid Osmotic Pressure and the Resolution of Refractory Ascites After Transjugular Intrahepatic Portosystemic Shunt

This study compared the changes in serum albumin, globulin, and colloid osmotic pressure (COP) before and after transjugular intrahepatic portosystemic shunt (TIPS) or large volume paracentesis (LVP) in patients with ascites. Of 23 patients with refractory ascites, 17 had TIPS and 6 had LVP with infusion of albumin. Colloid osmotic pressure measurements were calculated, using the formula previously proposed by Hoefs: COP = A (1.058G + 0.163A + 3.11) where A = serum albumin and G = serum globulin. After 1 month, ascites resolved in 9 of the 17 patients who had TIPS and in none of the 6 who had LVP. Colloid osmotic pressure increased significantly in patients whose ascites resolved after TIPS. Colloid osmotic pressure did not change in the patients whose ascites did not resolve after TIPS, and COP decreased significantly in the LVP group. A statistically significant difference was found in the pre-TIPS COP measurements between those patients who had resolution of ascites and those who did not. A pre-TIPS COP of < or =20 mm Hg predicted resolution of ascites with an 88% sensitivity and a 78% specificity. Serum COP increased significantly in patients with resolution of ascites but remained unchanged in patients with persistent ascites after TIPS. Serum COP decreased after LVP. A statistically significant difference in the pre-TIPS COP was found between patients whose ascites resolved and patients having persistent ascites.

Sampling of interstitial fluid and measurement of colloid osmotic pressure (COPi) in pigs: evaluation of the wick method.

The wick method for sampling of interstitial fluid from subcutis was applied in fluid balance studies in young pigs. Colloid osmotic pressure was measured in serum (COPs) and interstitial fluid (COPi) using a membrane colloid osmometer. Our aims were to determine the 'true' COPi, and to find the optimal duration of wick implantation. In series I (n = 6) a 'crossover' experiment was performed using wicks soaked in different priming solutions (non-diluted and diluted serum protein solutions or isotonic salt solution). Circulatory arrest was induced just before wick insertion in order to eliminate the vascular part of the acute inflammation. In series II (n = 6) wicks were removed in sequence after 60, 90, 120 and 180 min sampling time in anaesthetized pigs in vivo. COPs, COPi and haematocrit (HCT) together with haemoglobin (Hgb), serum albumin and total protein concentrations were determined in the same animals. In series I average COPs and COPi were 13.7 (1.4) and 7.2 (1.4) mmHg respectively (SD). In series II the optimal wick implantation times were estimated to be 60-90 min for wicks soaked in diluted protein solution, and 90-120 min for dry and saline-soaked wicks. COPs averaged 13.0 (0.7) mmHg, HCT 30.0 (1.6)%, Hgb 8.3 (0.9) g/dl, s-albumin 22.7 (0.6) g/l and s-protein 47.3 (2.3) g/l. Compared to commonly reported reference values, we found surprisingly low values for most of the measured variables. This may be related to the fact that we used immature pigs. An analysis of the validity of the wick method based on our own results and published reports is presented. We conclude that sampling of interstitial fluid with subcutaneous wicks is easy to perform in young pigs. However, the COP-values measured in wick fluid have to be carefully evaluated especially when sampling is performed in vivo.

Physicochemical and Immunochemical Properties of Recombinant Human Serum Albumin fromPichia pastoris

We analyzed and compared the physicochemical and immunochemical properties of recombinant human serum albumin (rHSA) fromPichia pastoriswith those of plasma-derived human serum albumin (pHSA). The second virial coefficient of rHSA, obtained from colloid osmotic pressure measurements at pH 6.7 ± 0.1 was not significantly different from that of pHSA (P> 0.05). A 25% rHSA solution exhibited Newtonian flow, and the viscosity of 25% rHSA at 20 ± 0.02°C was not significantly different from that of 25% pHSA (P> 0.05). We analyzed the long- and medium-chain fatty acid composition of rHSA by reverse-phase HPLC using 9-anthryldiazomethane as the fluorescent labeling reagent. The total amount of fatty acid was higher for pHSA than for rHSA. The fatty acid composition of the rHSA preparation was the same as that of the pHSA preparation. However, the amounts of palmitic acid (C16:0) and stearic acid (C18:0) in rHSA were much lower than those in pHSA. Interestingly, we found thatP. pastorisproduced linolenic acid (C18:3) because it was detected in rHSA. The immunochemical properties of rHSA were analyzed by a parallel line assay method using anti-pHSA polyclonal antibody, and were identical to those of pHSA (P> 0.05).

Measurement of Colloid Osmotic Pressure in Pregnancy Induced Hypertensive Patients

Measurement of Colloid Osmotic Pressure in Pregnancy Induced Hypertensive Patients

Changes in blood flow distribution and capillary function after deep hypothermia in rat

The present experiments were carried out in the rat to investigate the peripheral vascular function prior to the development of posthypothermic circulatory collapse. In the first study, mean arterial blood pressure, heart rate, cardiac output, regional blood flow, and plasma volume of hypothermic (4 h, 15-13 degrees C) and rewarmed rats were compared with normothermic controls. In response to hypothermia, arterial blood pressure, heart rate, and cardiac output declined markedly. After rewarming, arterial blood pressure and heart rate recovered fully, whereas cardiac output was only 33 +/- 7% of the control value (p < 0.025). Tissue blood flow was markedly depressed during hypothermia (p < 0.025), except for the abdominal skin. After rewarming, blood flow in skeletal muscle returned to within control levels, whereas blood flow in internal organs remained low (p < 0.025 vs. control). Posthypothermic plasma volume was 77 +/- 3% of control (p < 0.05). In the second study, the transcapillary colloid osmotic pressure gradient (COPp-COPi) was calculated following measurement of colloid osmotic pressure in plasma (COPp) and interstitium (COPi) in prehypothermic, hypothermic, and posthypothermic rats. The posthypothermic value of COPp-COPi was 76 +/- 4% of the prehypothermic value (p < 0.05). In conclusion this study demonstrates that the reduced cardiac output in rewarmed rats is associated with an altered regional blood flow distribution compared with that of normal rats. Capillary integrity also seemed perturbed. Thus, changes in both control and function of the peripheral vasculature are important mechanisms in the development of a posthypothermic circulatory collapse.

An Evaluation of Three Methods for Determining Colloid Osmotic Pressure

Plasma colloid osmotic pressure (COP) is an important determinant in edema formation. Three methods for assessing the COP were evaluated. Direct measurement of COP using the 4420 Wescor Colloid Osmometer was compared to the estimation of COP from both serum total protein and total serum solids (TSS) determinations. Blood samples from twenty adult patients (mean age = 64 years) undergoing cardiopulmonary bypass surgery were collected for COP assessment. Sample collection was performed prior to heparinization/hemodilution, during hypothermic bypass and at the conclusion of bypass following protamine administration. The results obtained from each method were analyzed by a two-way analysis of variance. The Bonferroni technique was used for comparison of sample means when the difference was significant (p&lt;0.05). Correlations were reported by linear regression analysis. A statistically significant difference (p&lt;0.01) was found between the three methods. A regression equation for the estimation of COP from total serum solids is offered: COP = (3.02 * TSS) + 0.65. Prospective clinical testing between the direct COP measurement and the estimation of COP from TSS using the equation (n=38) revealed a significant correlation (R2 = .932) and no significant difference between the two (p &gt; 0.05).

Clinical significance of serum colloid osmotic pressure in relation to pulmonary edema and coronary instability in patients with unstable angina.

Several investigators demonstrated that severe reduction of colloid osmotic pressure (COP) predicts a fatal outcome in patients with cardiopulmonary failure. To evaluate the clinical significance of COP in relation to pulmonary edema, we studied 117 patients with unstable angina admitted in the hospital within 24 h after the chest pain. The mean COP of all 117 patients was 24.8 +/- 3.7 mmHg. COP was significantly lower in patients with pulmonary edema, according to the chest x-ray findings, compared with the patients without it. Among 26 patients with emergency coronary arteriography, a fairly good correlation was observed between coronary jeopardy score and COP (r = -0.57, p less than 0.005). Furthermore, COP in patients who survived 26 months after the hospital discharge was significantly higher than that of the nonsurvivors. Thus, measurement of COP is advised for monitoring patients with unstable angina.

A simple colloid osmometer and determination of some factors influencing the measurement of colloid osmotic pressure in rat serum

A simple colloid osmometer and determination of some factors influencing the measurement of colloid osmotic pressure in rat serum

Subcutaneous interstitial fluid colloid osmotic pressure in dehydrated rats.

We collected interstitial fluid for measurement of colloid osmotic pressure (COPi) of normally hydrated and dehydrated rats with two methods: (1) saline-soaked nylon-wicks implanted in vivo for 1 h; and (2) the crossover method, i.e. titration with wicks pre-loaded with serial dilutions of rat plasma implanted post mortem for 15-20 min. All wicks were implanted in subcutis on the back. Dehydration was induced by injection of 40 mg furosemide followed by 24 h water deprivation. The saline-soaked wick method gave an average control COPi of 10.8 mmHg, 2-3 mmHg lower than the corresponding pressure obtained with the crossover method. This discrepancy between the methods increased to 10-11 mmHg in dehydrated animals, indicating that the saline-soaked wick method underestimates COPi even more during dehydration than during control conditions. The mean COPi of 22.8 mmHg (SD = 3.7, n = 9) obtained in dehydrated rats using the crossover method corresponds well with what is to be expected from the reduction in interstitial fluid volume. The present study suggests that the frequently used implantation period for saline-soaked wicks of 60 min should be prolonged to 90-120 min. It further shows that the rise in COPi is about 3 times more important than the fall in interstitial fluid hydrostatic pressure in restricting mobilization of interstitial fluid during dehydration.

Colloid osmotic pressure of interstitial fluid in rat subcutis and skeletal muscle: comparison of various wick sampling techniques.

Interstitial fluid for measurement of colloid osmotic pressure (COPi) was collected from rat subcutis and skeletal muscle with three wick methods; saline-soaked wicks implanted in vivo, titration with wicks preloaded with serial dilutions of rat plasma implanted postmortem (crossover method) and dry wicks implanted in vivo and post-mortem. When compared in 12 rats, the mean subcutaneous COPi of 14.2 and 13.3 mmHg as estimated with the crossover method and dry wick method, respectively, both exceeded the 10.7 mmHg obtained in saline-soaked wicks implanted for 60 min. Colloid osmotic pressure (COP) in fluid from dry wicks implanted subcutaneously was slightly lower than in plasma 5 min after implantation in vivo, then fell gradually, but remained stable the last 30 min of the 60 min in vivo implantation period and the first 30 min post-mortem, when again starting to rise. COP in fluid isolated from dry wicks implanted in muscle post-mortem approached or even exceeded that of plasma, suggesting leakage of intracellular proteins to wick fluid. Electrophoresis of dry wick fluid from subcutis showed a pattern similar to that of plasma, while protein fractions not present in plasma were observed in muscle wick fluid. For measurement of COPi we recommend the use of dry wicks implanted post mortem for subcutis and saline-soaked or dry wicks implanted in vivo for 90-120 min for skeletal muscle.

Measurement of colloid osmotic pressure in submicrolitre samples.

A colloid osmometer for submicrolitre samples was constructed from solid polymethylmetacrylate and acrylnitrilmethylmetacrylate blocks, exposing a 0.85 mm diameter area of a Diaflo PM-30 ultrafiltration membrane. The unknown sample, contained in a 1-microliter glass micropipette, was applied to the membrane by suction, providing minimal exposure to air. The lower limit for successful application was 0.1-0.2 microliter. The accuracy of colloid osmotic pressure (COP) measurement depends strongly on the effective compliance of the pressure transducer. We tested three different systems: (i) A Hewlett-Packard 1280 'medical' transducer gave acceptable measurements on 1-microliter samples. In smaller samples (0.1-0.5 microliter) COP was underestimated, especially at COP greater than 10 mmHg. The equilibration time was 10-30 min. (ii) As (i), but with air pressure applied to the sample by a servoregulated pump, minimizing fluid transport through the membrane. Accurate measurements on 0.2-microliter samples were obtained in the course of 2-3 min, but the system required special instrumentation and some operating experience. (iii) An 'industrial' transducer, SensoNor AE-88o, with very low compliance, gave accurate measurements in the course of 1-3 min on samples as small as 0.1-0.2 microliter and COP up to 37 mmHg. We recommend system (iii) for samples smaller than 1 microliter.

Microvascular exchange and interstitial volume regulation in the rat: model validation.

A dynamic mathematical model is formulated and used to describe the distribution and transport of fluid and plasma proteins between the circulation, interstitial space of skin and muscle, and the lymphatics in the rat. Two descriptions of transcapillary exchange are investigated: a homoporous "Starling model" and a heteroporous "plasma leak model." Parameters used in the two hypothetical transport mechanisms are determined based on statistical fitting procedures between simulation predictions and selected experimental data. These data consist of interstitial fluid volume and colloid osmotic pressure measurements as a function of venous pressure for muscle and interstitial colloid osmotic pressure vs. venous pressure for skin. The values determined for the transport parameters compare well with data in the literature. The fully determined model is used to simulate steady-state conditions of hypoproteinemia, overhydration, and dehydration, as well as the dynamic response to changes in venous pressure and intravascularly administered protein tracers. Comparisons between the simulation predictions and experimental data for these various perturbations are made. The plasma leak model appears to provide a better description of microvascular exchange.

Measurement of colloid osmotic pressure in newborns

Measurement of colloid osmotic pressure in newborns