Bolus intravenous 0.9% saline, but not 4% albumin or 5% glucose, causes interstitial pulmonary edema in healthy subjects

Abstract

Rapid intravenous (iv) infusion of 0.9% saline alters respiratory mechanics in healthy subjects. However, the relative cardiovascular and respiratory effects of bolus iv crystalloid vs. colloid are unknown. Six healthy male volunteers were given 30 ml/kg iv 0.9% saline, 4% albumin, and 5% glucose at a rate of 100 ml/min on 3 separate days in a double-blinded, randomized crossover study. Impulse oscillometry, spirometry, lung volumes, diffusing capacity (DLCO), and blood samples were measured before and after fluid administration. Lung ultrasound B-line score (indicating interstitial pulmonary edema) and Doppler echocardiography indices of cardiac preload were measured before, midway, immediately after, and 1 h after fluid administration. Infusion of 0.9% saline increased small airway resistance at 5 Hz (P = 0.04) and lung ultrasound B-line score (P = 0.01) without changes in Doppler echocardiography measures of preload. In contrast, 4% albumin increased DLCO, decreased lung volumes, and increased the Doppler echocardiography mitral E velocity (P = 0.001) and E-to-lateral/septal e' ratio, estimated blood volume, and N-terminal pro B-type natriuretic peptide (P = 0.01) but not lung ultrasound B-line score, consistent with increased pulmonary blood volume without interstitial pulmonary edema. There were no significant changes with 5% glucose. Plasma angiopoietin-2 concentration increased only after 0.9% saline (P = 0.001), suggesting an inflammatory mechanism associated with edema formation. In healthy subjects, 0.9% saline and 4% albumin have differential pulmonary effects not attributable to passive fluid filtration. This may reflect either different effects of these fluids on active signaling in the pulmonary circulation or a protective effect of albumin.

Fluid bolus therapy in emergency department patients: Indications and physiological changes

“…2,3,5 Despite these large clinical studies in the ED, there is very little evidence addressing the question of whether FBT achieves the expected physiological responses. 22 FBT (often administered at room temperature) was associated with a decrease in body temperature, an observation similarly reported in ICU patients. 16 In particular, in our study, even in patients presenting with shock or septic shock the magnitude of the increase in MAP at 1 h was small.…”

“…22 Finally, this is not a randomised controlled study, and we do not know what would have happened to these patients if they had not received FBT. First, it is single centre in nature, and, despite our best efforts to capture the majority of the FBT with repeated in-service Similarly some of the haemodynamic data at 2 h were not recorded if the patient was transferred to the ward/ICU where they may have had additional fluids or vasopressors administered.…”

“…However, MAP and HR changes were not sustained at 1 and 2 h after the administration of FBT. In contrast, body temperature (°C) decreased (37.3 [36.5-37.7] to 36.7 [36.1-37.5]; P < 0.01 at 1 h, 37.3 [36.5-37.7] to 36.5 [36.0-37.5]; P < 0.01 at 2 h) and RR (per min) increased (19 [16-23] to 23 [18][19][20][21][22][23][24][25]; P < 0.01 at 1 h, 19 [16][17][18][19][20][21][22] to 22 [18][19][20][21][22][23][24]; P = 0.03 at 2 h) ( Table 3).…”

“…In patients with shock and septic shock, 1 h after FBT, there was a smallbut significant increase in MAP [16][17][18][19][20][21][22] to 22 [18][19][20][21][22][23][24]; P < 0.01, 19 [16][17][18][19][20][21][22][23][24] to 22 [19][20][21][22][23][24][25]; P = 0.01, respectively) and no change in HR (Table 4).…”

In silico model of the dilutional effects of conventional component therapy versus whole blood in the management of massively bleeding adult trauma patients

“…38 CPD and the various ASs that are found in blood components have different compositions and higher osmolarities compared to normal saline and other crystalloid solutions. 1,39 Thus, while the adverse effects following the administration of crystalloid fluids-especially normal saline-are beginning to be appreciated, 7,[40][41][42] it is not clear if the non-oxygen-carrying, nonhemostatic fluids that are transfused along with the blood products would similarly contribute to these adverse effects. Nevertheless, at a minimum, the non-oxygen-carrying, nonhemostatic fluids that are transfused along with the blood products would contribute to the overall fluid load that the patient receives.…”