Haemodynamic effect of a 20% albumin fluid bolus in post-cardiac surgery patients

Salvatore L. Cutuli, Laurent Bitker, Eduardo A. Osawa, Zachary O'Brien, Emmanuel Canet, Fumitaka Yanase, Paolo Ancona, Anthony Wilson, Luca Lucchetta, Mark Kubicki, Maria Cronhjort, Luca Cioccari, Lea Peck, Helen Young, Glenn M. Eastwood, Johan Mårtensson, Neil J. Glassford, Rinaldo Bellomo

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OBJECTIVE: To study the cardiovascular effect over 30 minutes following the end of fluid bolus therapy (FBT) with 20% albumin in patients after cardiac surgery. DESIGN: Prospective observational study. SETTING: Intensive care unit of a tertiary university-affiliated hospital. PARTICIPANTS: Twenty post-cardiac surgery mechanically ventilated patients with a clinical decision to administer FBT. INTERVENTION: FBT with a 100 mL bolus of 20% albumin. MAIN OUTCOME MEASURES: Cardiac index (CI) response was defined by a ≥ 15% increase, while mean arterial pressure (MAP) response was defined by a ≥ 10% increase. RESULTS: The most common indication for FBT was hypotension (40%). Median duration of infusion was 7 minutes (interquartile range [IQR], 3-9 min). At the end of FBT, five patients (25%) showed a CI response, which increased to almost half in the following 30 minutes and dissipated in one patient. MAP response occurred in 11 patients (55%) and dissipated in five patients (45%) by a median of 6 minutes (IQR, 6-10 min). CI and MAP responses coexisted in four patients (20%). An intrabolus MAP response occurred in 17 patients (85%) but dissipated in 11 patients (65%) within a median of 7 minutes (IQR, 2-11 min). On regression analysis, faster fluid bolus administration predicted MAP increase at the end of the bolus. CONCLUSION: In post-cardiac surgery patients, CI response to 20% albumin FBT was not congruous with MAP response over 30 minutes. Although hypotension was the main indication for FBT and a MAP response occurred in most of patients, such response was maximal during the bolus, dissipated in a few minutes, and was dissociated from the CI response.

Original languageEnglish
Pages (from-to)15-25
Number of pages11
JournalCritical Care and Resuscitation
Issue number1
Publication statusPublished - Mar 2020

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