Hemodynamic effects of volume expansion in patients with cardiac tamponade

Article

关键词: ACUTE PERICARDIAL TAMPONADE;    PERICARDIOCENTESIS;    ECHOCARDIOGRAPHY;    NITROPRUSSIDE;    DIAGNOSIS;   

DOI  :  10.1161/CIRCULATIONAHA.107.737841

来源: SCIE

【 摘 要 】

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 < 100 mm Hg and low cardiac index. Conclusions - Approximately one half of patients with cardiac tamponade develop a significant increase in cardiac output after volume overload. Low systolic blood pressure (< 100 mm Hg) at baseline was the simplest clinical finding that was predictive of this favorable response.

【 授权许可】

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