Hemodynamic effects of fluid loading in acute massive pulmonary embolism.
OBJECTIVE
To assess the hemodynamic effects of fluid loading in patients with acute circulatory failure caused by acute massive pulmonary embolism (AMPE).


METHODS
Prospective study.


METHODS
Respiratory critical care unit of a university hospital.


METHODS
Thirteen patients free of previous cardiopulmonary disease with angiographically proven AMPE (Miller index = 24 +/- 1), with acute circulatory failure defined by a cardiac index (CI) lower than 2.5 L/min/m2.


METHODS
Infusion of 500 mL of dextran 40 over 20 mins.


RESULTS
Fluid loading induced a substantial increase in right atrial pressure from 9 +/- 1 mm Hg to 17 +/- 1 mm Hg and in right ventricular end-diastolic volume index from 123 +/- 14 mL/m2 to 150 +/- 11 mL/m2 (p < .05 for both comparisons). The increase in right ventricular preload was associated with an increase in Cl from 1.6 +/- 0.1 to 2.0 +/- 0.1 L/min/m2 (p < .05), whereas right ventricular ejection fraction (15 +/- 3% at baseline vs. 16 +/- 3% after fluid loading) and total pulmonary vascular resistance index (1689 +/- 187 dyne x sec/cm5 x m2 at baseline vs. 1492 +/- 166 dyne x sec/ cm5 x m2 after fluid loading) remained unchanged. The increase in Cl induced by fluid loading was inversely correlated to baseline right ventricular end-diastolic volume index (r = -.89 ; p< .05).


CONCLUSIONS
These results suggest that fluid loading can improve hemodynamic status in patients with acute circulatory failure caused by AMPE.
Mercat
A
A
Medical ICU, Hopital de Bicêtre, Université Paris XI, France.
Diehl
J L
JL
Meyer
G
G
Teboul
J L
JL
Sors
H
H
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003422:Critical Care; D003911:Dextrans / Q000008:administration & dosage*; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D012769:Shock / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
D003911:Dextrans; D010952:Plasma Substitutes