Transcapillary forces of the subcutaneous tissue in patients with coronary artery disease: a comparison between pulsatile and nonpulsatile flow during extracorporeal circulation

Abstract

The aim of this study was to evaluate subcutaneous transcapillary fluid balance during pulsatile and nonpulsatile extracorporeal circulation (ECC). Changes in the transcapillary fluid balance were studied by measuring subcutaneous interstitial fluid pressure (P_if) using the 'wick in needle' (WIN) method, as well as measuring subcutaneous interstitial fluid colloid osmotic pressure (COP_if), using either the wick technique or the blister suction technique. The measurements were performed on the chest wall at the heart level. Simultaneous recordings of plasma colloid osmotic pressure (COP_pl) were carried out. Nineteen male patients undergoing aortocoronary bypass grafting were subjected to nonpulsatile flow (group I, n = 11) or pulsatile flow (group II, n = 8) during ECC. Preoperatively there was no difference in the Starling forces between the two groups. During ECC the COP gradient (COP_pl-COP _if) was reversed to the same extent in the two groups. At three hours and six hours following ECC, COP_if in the pulsatile group (12.1 mmHg and 11.4mmHg respectively) was significantly higher than in the nonpulsatile group (10.8mmHg and 10.3mmHg respectively). When weaning from ECC as well as three hours and six hours following ECC, P_if in the pulsatile group was significantly lower than in the nonpulsatile group. Conclusion: in the early postoperative period there is less dilution of the subcutaneous interstitial tissue following application of pulsatile flow during ECC compared to nonpulsatile flow.