General principles

All patients who have undergone cardiopulmonary bypass have significant shifts in their overall total body water. Cardiopulmonary bypass provides for significant dilution of the blood volume secondary to the crystalloid prime used to prime the pump. Cardiopulmonary bypass causes a significant increase in capillary permeability. These changes occur because of activation of the complement system, release of histamine from mast cells, release of serotonin from platelets, release of lysosomal enzymes from granulocytes and because of activation of the kinins. The overall result of these changes is marked increase in interstitial fluid. Following cardiopulmonary bypass patients can have an increase in the interstitial fluid volume of up to 150 cc/kg of body weight. One may safely assume that all patients who have undergone cardiopulmonary bypass have a significant interstitial fluid load which must be relieved in the first few postoperative days.

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