Weight gain with oedema formation and decreased plasma proteins is frequently reported in patients undergoing major thoracic surgery. The significance and the clinical implications of such hydro-electrolytic imbalance is unclear. The aim of this observational study is to evaluate the amount and the distribution of the Total Body Water (TBW) along with the variation of specific hormones and electrolytes in patients submitted to pulmonary lobectomy for lung cancer. Materials & Methods: 34 consecutive patients were enrolled. The following data were analyzed before surgery and in postoperative (postop) day 1,3,5 and 7: body weight, adrenocorticotropic hormone (ACTH), serum and urinary cortisol, Atrial Natriuretic Peptide (ANP). Hydration was evaluated by hematocrit (Ht), blood urea and creatinine, plasma proteins, Sodium and Potassium value, urine osmolality. Monofrequency bio-impedance analysis (BIA) was utilized to quantify at the same time the water gain and redistribution of TBW. Results: There was no mortality and major morbidity. Estimated mean intraoperative blood loss was 250 ml. No blood transfusions were required. The following results were observed in all patients, up to postop day 4: increase of body weight (0.6-13.8%, range 0.500-9 kg), increase of ANP and of cortical-adrenal function, slight decrease of hematocrit and plasma proteins, probably due to hemodilution as confirmed by urea and creatinine values. Urine osmolality did not modified in the observational period. The mean bio-impedance derived reactance and mean body weight are depicted in fig 1. Restoration of the preoperative values was observed between day 5 and 7. Conclusions/Uploads: Our data show that postoperative gain weight and oedema formation, are related to the pronounced increase of corticoid-adrenal function in response to the surgical stress. Strict fluid restriction, diuretics and secondary secretion of ANP do not avoid such imbalance. Hemodilution seems to have a minor role. BIA is more sensitive then body weight to monitor fluid redistribution.
Fluid and electrolyte balance after major thoracic surgery by bioimpedance and endocrine evaluation
CAGINI, Lucio;SAVIGNANI, CLAUDIA;RAGUSA, Mark;ANGELETTI, Gabriella;PUMA, Francesco
2011
Abstract
Weight gain with oedema formation and decreased plasma proteins is frequently reported in patients undergoing major thoracic surgery. The significance and the clinical implications of such hydro-electrolytic imbalance is unclear. The aim of this observational study is to evaluate the amount and the distribution of the Total Body Water (TBW) along with the variation of specific hormones and electrolytes in patients submitted to pulmonary lobectomy for lung cancer. Materials & Methods: 34 consecutive patients were enrolled. The following data were analyzed before surgery and in postoperative (postop) day 1,3,5 and 7: body weight, adrenocorticotropic hormone (ACTH), serum and urinary cortisol, Atrial Natriuretic Peptide (ANP). Hydration was evaluated by hematocrit (Ht), blood urea and creatinine, plasma proteins, Sodium and Potassium value, urine osmolality. Monofrequency bio-impedance analysis (BIA) was utilized to quantify at the same time the water gain and redistribution of TBW. Results: There was no mortality and major morbidity. Estimated mean intraoperative blood loss was 250 ml. No blood transfusions were required. The following results were observed in all patients, up to postop day 4: increase of body weight (0.6-13.8%, range 0.500-9 kg), increase of ANP and of cortical-adrenal function, slight decrease of hematocrit and plasma proteins, probably due to hemodilution as confirmed by urea and creatinine values. Urine osmolality did not modified in the observational period. The mean bio-impedance derived reactance and mean body weight are depicted in fig 1. Restoration of the preoperative values was observed between day 5 and 7. Conclusions/Uploads: Our data show that postoperative gain weight and oedema formation, are related to the pronounced increase of corticoid-adrenal function in response to the surgical stress. Strict fluid restriction, diuretics and secondary secretion of ANP do not avoid such imbalance. Hemodilution seems to have a minor role. BIA is more sensitive then body weight to monitor fluid redistribution.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
