Hemodynamic Effects of Volume Expansion in Patients With Cardiac Tamponade
| Autor: | Jaume Sagristà-Sauleda, Juan Angel, G. Permanyer-Miralda, Antonia Sambola |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Mean arterial pressure Systole medicine.medical_treatment Cardiac index Hemodynamics Blood Pressure Sodium Chloride Pericardial effusion Physiology (medical) Internal medicine Cardiac tamponade medicine Humans Pericardium Cardiac Output Aged Blood Volume business.industry Middle Aged Prognosis medicine.disease Cardiac Tamponade Treatment Outcome medicine.anatomical_structure Pericardiocentesis Anesthesia Heart Function Tests Cardiology Tamponade Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 117:1545-1549 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Background— Volume expansion has been proposed as an alternative treatment for cardiac tamponade; however, the scientific evidence for this recommendation is very poor. Methods and Results— Forty-nine unselected patients (23 males; age 55±16 years) with large pericardial effusion and hemodynamic tamponade underwent fluid overload with intravenous administration of 500 mL of normal saline over 10 minutes. Cardiac index and intrapericardial, left ventricular end-diastolic, right atrial, and right ventricular end-diastolic pressures were measured during basal state (tamponade), after fluid overload, and after pericardiocentesis. Twenty-eight patients (57%) had physical signs of tamponade, and 10 (20%) were hypotensive. Size of pericardial effusion was 31±13 mm. Initial mean arterial pressure was 88±21 mm Hg, and cardiac index was 2.46±0.80 L · min −1 · m −2 . Intrapericardial pressure was 8.31±5.98 mm Hg. Volume expansion caused a significant increase in mean arterial pressure (from 88±21 to 94±23 mm Hg, P =0.003) and cardiac index (from 2.46±0.80 to 2.64±0.68 L · min −1 · m −2 , P =0.013), as well as in intrapericardial pressure (from 8.31±5.98 to 11.02±6.27 mm Hg, P =0.0001), right atrial pressure (from 9.76±5.91 to 12.82±6.34 mm Hg, P =0.0001), and left ventricular end-diastolic pressure (from 14.21±5.97 to 19.48±6.19 mm Hg, P =0.0001). Cardiac index increased by >10% in 23 patients (47%), remained unchanged in 11 (22%), and decreased in 15 (31%). No patient developed clinical complications. Predictors of this favorable response were systolic blood pressure Conclusions— Approximately one half of patients with cardiac tamponade develop a significant increase in cardiac output after volume overload. Low systolic blood pressure ( |
| Databáze: | OpenAIRE |
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