Increased capillary filtration may paradoxically accelerate vascular refill of both fluid and albumin from the interstitial space, which is claimed to be edema-preventing. We characterized this proposed mechanism, called “interstitial washdown”, by kinetic analyses of the hemodilution induced by intravenous infusion of crystalloid fluid during 3 distinct physiological states. Greater plasma dilution of hemoglobin as compared to albumin during fluid therapy indicated recruitment of albumin, which was compared to the flow of interstitial fluid to the plasma as indicated by population volume kinetic analysis. Data for the comparison were derived from 24 infusions of crystalloid fluid in conscious volunteers, 30 in anesthetized patients, and 31 in patients with ketoacidosis from hyperglycemia. “Interstitial washdown” increased the plasma albumin concentration by between 0.3 and 1.0 g/L in the three series of infusions. The initial albumin concentration in the interstitial fluid returning to the plasma was estimated to between 22 g/L and 29 g/L, which decreased to an average of 50–75% lower during the subsequent 2–3 h. Kinetic simulations show that pronounced washdown was associated with increased capillary filtration (high k12) and, in conscious subjects, with greater plasma and interstitial volume expansion and restricted urine flow. During anesthesia, the main effect was an increase in the non-exchangeable fluid volume (“third-spacing”). Crystalloid fluid accelerates lymphatic flow that moderately increases plasma albumin, but more clearly helps to maintain the intravascular volume. This “interstitial washdown” mechanism becomes exhausted after a few hours.

中文翻译：

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输液期间的间质冲洗和血管白蛋白补充：来自三项临床试验的新动力学分析

增加的毛细血管滤过可能相反地加速来自间质空间的液体和白蛋白的血管再填充，这被称为可预防水肿。我们通过对在 3 种不同生理状态下静脉输注晶体液引起的血液稀释进行动力学分析，对这种被称为“间质冲洗”的机制进行了表征。在液体治疗期间，与白蛋白相比，血红蛋白的血浆稀释度更大表明白蛋白的募集，这与通过群体体积动力学分析表明的间质液向血浆的流动进行比较。用于比较的数据来自清醒志愿者的 24 次晶体液输注，麻醉患者的 30 次输注，以及高血糖引起的酮症酸中毒患者的 31 次输注。在三个系列的输注中，“间质冲洗”使血浆白蛋白浓度增加了 0.3 至 1.0 g/L。返回血浆的组织液中的初始白蛋白浓度估计在 22 g/L 和 29 g/L 之间，在随后的 2-3 小时内降低到平均 50-75%。动力学模拟表明，明显的冲洗与毛细血管过滤增加（高 k12）有关，并且在有意识的受试者中，血浆和间质体积膨胀更大，尿流量受限。在麻醉期间，主要作用是增加不可交换的液体量（“第三间隔”）。晶体液加速淋巴流动，适度增加血浆白蛋白，但更明显地有助于维持血管内容量。