title: Bolus intravenous 0.9% saline, but not 4% albumin or 5% glucose, causes interstitial pulmonary edema in healthy subjects.
abstract: Rapid intravenous (iv) infusion of 0.9% saline alters respiratory mechanics in healthy subjects. However, the relative cardiovascular and respiratory effects of bolus iv crystalloid vs. colloid are unknown. Six healthy male volunteers were given 30 ml/kg iv 0.9% saline, 4% albumin, and 5% glucose at a rate of 100 ml/min on 3 separate days in a double-blinded, randomized crossover study. Impulse oscillometry, spirometry, lung volumes, diffusing capacity (DLCO), and blood samples were measured before and after fluid administration. Lung ultrasound B-line score (indicating interstitial pulmonary edema) and Doppler echocardiography indices of cardiac preload were measured before, midway, immediately after, and 1 h after fluid administration. Infusion of 0.9% saline increased small airway resistance at 5 Hz (P = 0.04) and lung ultrasound B-line score (P = 0.01) without changes in Doppler echocardiography measures of preload. In contrast, 4% albumin increased DLCO, decreased lung volumes, and increased the Doppler echocardiography mitral E velocity (P = 0.001) and E-to-lateral/septal e' ratio, estimated blood volume, and N-terminal pro B-type natriuretic peptide (P = 0.01) but not lung ultrasound B-line score, consistent with increased pulmonary blood volume without interstitial pulmonary edema. There were no significant changes with 5% glucose. Plasma angiopoietin-2 concentration increased only after 0.9% saline (P = 0.001), suggesting an inflammatory mechanism associated with edema formation. In healthy subjects, 0.9% saline and 4% albumin have differential pulmonary effects not attributable to passive fluid filtration. This may reflect either different effects of these fluids on active signaling in the pulmonary circulation or a protective effect of albumin.
authors.affiliation: Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia; Department of Critical Care Medicine, Flinders University, Adelaide, Australia; biharishailesh@gmail.com.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Bihari
authors.affiliation: Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia;
authors.forename: Ubbo F
authors.initials: UF
authors.lastname: Wiersema
authors.affiliation: Department of Respiratory Medicine, Flinders Medical Centre, Adelaide, Australia;
authors.forename: David
authors.initials: D
authors.lastname: Schembri
authors.affiliation: Cardiology, Flinders Medical Centre, Adelaide, Australia; and Department of Medicine, Flinders University, Adelaide, Australia.
authors.forename: Carmine G
authors.initials: CG
authors.lastname: De Pasquale
authors.affiliation: Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia; Department of Critical Care Medicine, Flinders University, Adelaide, Australia;
authors.forename: Dani-Louise
authors.initials: DL
authors.lastname: Dixon
authors.affiliation: Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia;
authors.forename: Shivesh
authors.initials: S
authors.lastname: Prakash
authors.affiliation: Department of Critical Care Medicine, Flinders University, Adelaide, Australia;
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lawrence
authors.affiliation: Department of Respiratory Medicine, Flinders Medical Centre, Adelaide, Australia;
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Bowden
authors.affiliation: Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia; Department of Critical Care Medicine, Flinders University, Adelaide, Australia;
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Bersten
mesh_terms: D000328:Adult; D000418:Albumins; D042702:Angiopoietin-2 / Q000097:blood; D001810:Blood Volume; D002302:Cardiac Output; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005950:Glucose Solution, Hypertonic; D064368:Healthy Volunteers; D006801:Humans; D007262:Infusions, Intravenous; D008176:Lung Volume Measurements; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000000981:diagnostic imaging; D015656:Respiratory Mechanics; D012965:Sodium Chloride; D012996:Solutions; D014463:Ultrasonography; D055815:Young Adult
chemical_list: C586513:ANGPT2 protein, human; D000418:Albumins; D042702:Angiopoietin-2; D005950:Glucose Solution, Hypertonic; D012996:Solutions; D020097:Natriuretic Peptide, Brain; D012965:Sodium Chloride
keywords: 0.9% saline; 4% albumin; 5% glucose; cardiac output; pulmonary edema; ultrasound