Albumin/fluids and svr - page 3

by Zaphod

Ok, open heart RN's. Does Albumin increase SVR? Do isotonic solutions increase SVR? I was under the thinking that Albumin does, but was assured otherwise. Thank you guys and girls:)... Read More

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    They tend to run our hearts dry; so immediate post-op they often need albumin to help with preload, cardiac output, or hypotension; of course blood is best! You could try some with high SVR, but we tend not to treat the SVR in general unless its sky high. We also tend not to give Levophed or Neo on this patient population; we use Dopamine, Epi, & even Vasopressin. I think it's the preference of the surgeon though. Oh, some the anesthesiologists give Lasix or mannitol at the end of the case if they ran wet instead.
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    TakeBack - Your definition regarding flow is a misconstrued deviation of Ohms law that actually incorporates resistance twice (V=IR). Tone is generally referred to as resistance and if examined separately is still the driving force of resistance (increase vascular tone = increase resistance). Additionally, your hypothetical situation involving Delta P = CO X SVR (V=IR) is nothing more than that. A textbook definition can use these types of variables in order to describe a particular situation but that is generally not the case in the real world. Stating that someone has “fixed tone and CO” is similar to describing the effects of an increased preload by stating that it will increase stroke volume, increase end diastolic volume, etc. and neglecting to include the response of the right atrium (Bainbridge reflex, ANP release, etc.).
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    I think we're getting at the same idea from different sides.It's impossible to predict the result of one intervention (say, volume loading/increased SV) when the other variables are not fixed. It sounds like we agree that textbook scenarios don't uniformly apply to real pts.

    Regarding resistance, I am referring to both the static and dynamic aspects. The isolated contstrictive state of the VSM will have a dynamic effect on the flow generated by the CO (producing what we measure as the SVR). The degree of vasoconstriction produces the variable SVR in our calculations (using CO and MAP).

    Analagous to peak and plateau airway pressures.
    asn97 likes this.
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    Please I just want to know, what is the aim of these questions?
    providing information , brain storming, or discussion ?
    thank you