[Principles of optimization of infusion therapy in critical conditions]

Hemodynamic and pulmonary gas exchange reactions to albumin test were different in 45 critical patients. Four types of reactions to albumin test have been identified and formed the basis for selection of the infusion therapy. In type 1 colloid-osmotic plasma pressure and pulmonary wedge pressure increased, in type 1B there was a critical increase in pulmonary wedge pressure; in type 2 colloid-osmotic pressure always decreased, and in type 2A this decrease was accompanied by a drop in arterial blood pO2. It may be assumed that in patients from group 1 albumin is retained in the vascular bed and thus the protein permeability function of the pulmonary vessels endothelium is not damaged. Colloid-osmotic pressure lowering in patients from group 2 is indicative of increased vascular permeability for protein molecules, which can be combined with lymphatic drainage inhibition in the lung interstitium (type 2B). It is obvious that transfusion of colloid solutions is not indicated in type 2 reactions to albumin test, while in type 1 such transfusions may have a favourable effect on hemodynamics and pulmonary gas exchange.