Hemodynamic Effects of Volume Expansion in Patients With Cardiac Tamponade

Abstract

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 55Ϯ16 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 31Ϯ13 mm. Initial mean arterial pressure was 88Ϯ21 mm Hg, and cardiac index was 2.46Ϯ0.80 L · min Ϫ1 · m

Pleural effusion in the mechanically ventilated patient

“…Other factors such as spontaneous breathing activity, cardiac reserve, intravascular volume status, and compliance of the lung and chest wall probably interact, their resultant determining the effect of PLEF on cardiac performance. For example, volume expansion can increase CO and arterial pressure in patients with cardiac tamponade -particularly if they are hypotensive [44]. Such behavior implies that even if a patient with PLEF presents with tamponade-like physiology, an associated reduction in CO may be reversed by fluid infusion, thereby preventing the potential phenomenon from detection.…”

Cardiac tamponade

“…Cardiac tamponade was defined as equalization between right atrial and pericardial pressures, with a right atrial transmural pressure less than 2 mmHg. Fluid loading led to a significant increase in the mean arterial pressure (94 AE 23 vs. 88 AE 21 mmHg), intrapericardial pressure 11.02 AE 6.27 vs. 8.31 AE 5.98 mmHg), right atrial pressure (12.82 AE 6.34 vs. 9.76 AE 5.91 mmHg), and left ventricular enddiastolic pressure (19.48 AE 6.19 vs. 14.21 AE 5.97 mmHg) [29]. However, only 48% patients had an increase in cardiac index greater than 10%, whereas 31% had a decrease without clinical consequence [29].…”

“…The aim is also to maintain an accep- Few data from old animal studies [26,27] and small numbers of patients [28] show some controversial results. In a recent work, Sagristà-Sauleda et al [29] studied on 49 patients with cardiac tamponade the effect of a fluid loading with 500 ml of saline over 10 min. Cardiac tamponade was defined as equalization between right atrial and pericardial pressures, with a right atrial transmural pressure less than 2 mmHg.…”

Hypovolemia-induced Cardiac Tamponade in a Patient with Hypothyroidism

“…In hypothyroid patients with cardiac tamponade, pericardiocentesis is indicated for rapid relief of tamponade (7). An intravenous volume load should be administered to hypotensive patients while they are being prepared for pericardiocentesis (8). Before the restoration of thyroid function, relapse of pericardial effusion is common after needle pericardiocentesis.…”