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Hemodynamic effects of fluid loading in acute massive pulmonary embolism

Mercat, Alain MD; Diehl, Jean-Luc MD; Meyer, Guy MD; Teboul, Jean-Louis MD, PhD; Sors, Herve MD

Clinical Investigations

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

Design Prospective study.

Setting Respiratory critical care unit of a university hospital.

Patients 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.

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

Measurements and Main 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 CI 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[center dot]sec/cm5 [center dot]m2 at baseline vs. 1492 +/- 166 dyne[center dot]sec/cm (5) [center dot]m2 after fluid loading) remained unchanged. The increase in CI 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. (Crit Care Med 1999; 27:540-544)

From the Respiratory Critical Care Unit, Hopital Laennec, Universite Paris V, France.

(Drs. Diehl, Meyer, and Sors); and the Medical ICU, Hopital de Bicetre, Universite Paris XI, France (Drs. Mercat and Teboul).

This study was promoted by the Direction de la Recherche Clinique de I'Assistance Publique-Hopitaux de Paris (projet P 940314).

Address requests for reprints to: Dr. Alain Mercat, Service de Reanimation Medicale. Hopital de Bicetre, 78, rue du General Leclerc, 94275 Le Kremlin Bicetre, France.

© 1999 Lippincott Williams & Wilkins, Inc.