Chest
Volume 72, Issue 6, December 1977, Pages 709-713
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Clinical Investigations
Colloid Osmotic Pressure as a Prognostic Indicator of Pulmonary Edema and Mortality in the Critically Ill

https://doi.org/10.1378/chest.72.6.709Get rights and content

The relationship of colloid osmotic pressure (COP) to pulmonary edema and mortality in 128 critically ill patients was investigated in our critical care unit, and confirms previously reported observations. The COP in the 86 survivors was 22.0 (± 0.4 SEM) mm Hg versus 17.2 (± 0.6 SEM) mm Hg in the 42 who died (P < 0.001). The patients were divided into three groups: 71 with no pulmonary edema, COP of 21.5 (± 0.5 SEM) mm Hg; 40 with cardiogenic pulmonary edema, COP of 21.4 (± 0.4 SEM) mm Hg; and 17 with noncardiogenic pulmonary edema, COP of 13.6 (± 0.8 SEM) mm Hg. Colloid osmotic pressure was significantly lower in patients with noncardiogenic pulmonary edema (P < 0.001). In 36 patients in whom pulmonary artery wedge pressures (PWP) were available, a COP-PWP gradient of 4.0 mm Hg or less was always associated with pulmonary edema, while a COP-PWP gradient greater than 4.0 mm Hg was never associated with pulmonary edema. Colloid osmotic pressure is a useful prognostic indicator of pulmonary edema and mortality in the critically ill. Pulmonary edema is a frequent complication in the critically ill patient. Alterations in the forces influencing fluid filtration and clearance and/or the factors influencing capillary permeability may cause

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MATERIALS AND METHODS

The study included 128 consecutive admissions to the Kings County Hospital critical care unit from January, 1976 through Mardi, 1976. The patient population was composed of 67 men and 61 women whose ages ranged from 15 to 94 (median = 64). Eighty-six patients survived to leave the hospital and 42 expired. The primary diagnoses are summarized in Table 1.

Central venous blood samples were taken from each patient for total protein, albumin, and serum colloid osmotic pressure (COP) determinations

RESULTS

The mean COP of all 128 critically ill patients was 20.4 (± 0.4 SEM) mm Hg (Fig 1). This was significantly lower than that of our normal subjects (P < 0.001). The critically ill patients were divided into three groups on the basis of chest roentgenograms, clinical diagnosis, and PWP when available: no pulmonary edema (NPE); cardiogenic pulmonary edema (CPE); and noncardiogenic pulmonary edema (NCPE) (Table 2). The mean grade of pulmonary edema on chest roentgenograms was 3.2 (± 0.1 SEM) in both

DISCUSSION

The Starling fluid transport equation1 describes the net flux of fluid across a capillary membrane under steady state conditions: Fluidflux=K(Pc+πiPiπc)where K is the filtration coefficient in milliliters per second per centimeter2 per mm Hg, Pc is the capillary hydrostatic pressure in mm Hg (ie, PWP), π1 is the osmotic pressure of interstitial protein in mm Hg, P1 is the interstitial hydrostatic pressure in mm Hg, and πe is the osmotic pressure of plasma protein in mm Hg (ie, COP). The

ACKNOWLEDGMENTS

We wish to thank Mitchell Horowitz, Anthony Babich, Sylvia Berman and the medical housestaff of the Kings County Hospital Center for their contributions to this study.

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    Manuscript received January 21; revision accepted April 6.

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