| Abstract | INTRODUCTION: Resuscitation with saline is a standard initial response to hypotension or shock of almost any cause. Saline resuscitation is thought to generate an increase in cardiac output through a preload-dependent (increased end-diastolic volume) augmentation of stroke volume. We sought to confirm this to be the mechanism by which high-volume saline administration (comparable to that used in resuscitation of shock) results in improved cardiac output in normal healthy volunteers. METHODS: Using a standardized protocol, 24 healthy male (group 1) and 12 healthy mixed sex (group 2) volunteers were infused with 3 l normal (0.9%) saline over 3 hours in a prospective interventional study. Individuals were studied at baseline and following volume infusion using volumetric echocardiography (group 1) or a combination of pulmonary artery catheterization and radionuclide cineangiography (group 2). RESULTS: Saline infusion resulted in minor effects on heart rate and arterial pressures. Stroke volume index increased significantly (by approximately 15-25%; P < 0.0001). Biventricular end-diastolic volumes were only inconsistently increased, whereas end-systolic volumes decreased almost uniformly. Decreased end-systolic volume contributed as much as 40-90% to the stroke volume index response. Indices of ventricular contractility including ejection fraction, ventricular stroke work and peak systolic pressure/end-systolic volume index ratio all increased significantly (minimum P < 0.01). CONCLUSION: The increase in stroke volume associated with high-volume saline infusion into normal individuals is not only mediated by an increase in end-diastolic volume, as standard teaching suggests, but also involves a consistent and substantial decrease in end-systolic volumes and increases in basic indices of cardiac contractility. This phenomenon may be consistent with either an increase in biventricular contractility or a decrease in afterload. |
| Authors | Anand Kumar, Ramon Anel, Eugene Bunnell, Sergio Zanotti, Kalim Habet, Cameron Haery, Stephanie Marshall, Mary Cheang, Alex Neumann, Amjad Ali, Clifford Kavinsky, Joseph E Parrillo
(Affiliation: Division of Cardiovascular Diseases and Critical Care Medicine, Cooper Hospital/University Medical Center, Robert Wood Johnson Medical School, Camden, New Jersey, USA. akumar61 at yahoo.com)
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| Journal | Critical care (London, England)
(Crit Care)
Vol. 8
Issue 3
Pg. R128-36
(Jun 2004)
ISSN: 1466-609X England |
| PMID | 15153240
(Publication Type: Clinical Trial, Journal Article)
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| Chemical References |
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| Topics |
- Adolescent
- Adult
- Blood Pressure
(drug effects)
- Cardiac Volume
(drug effects)
- Catheterization, Swan-Ganz
- Cineangiography
(methods)
- Echocardiography
- Female
- Gated Blood-Pool Imaging
- Heart Rate
(drug effects)
- Humans
- Infusions, Intravenous
- Intervention Studies
- Male
- Myocardial Contraction
(drug effects)
- Prospective Studies
- Resuscitation
(methods)
- Shock
- Sodium Chloride
(administration & dosage)
- Stroke Volume
(drug effects)
- Ventricular Function, Left
(drug effects)
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