Changes to cardiac output and left ventricular work indices following a 200 ml bolus of 20% albumin

Objectives

We have previously described a technique for the measurement of vascular permeability (the Albumin Distribution Index, ADI) which entails the bolus administration of 200 ml of 20% albumin solution. This hypertonic solution causes a fall in ionised calcium levels, possibly reducing contractility, and in the septic patient with myocardial depression theoretically might lead to left ventricular overload and dysfunction. This study set out to investigate to what degree this occurs.

Design

Prospective observational study.

Subjects

Fifteen adult patients with clinical septic shock, median APACHE II score 17 (± 3), mean age 47 (± 16) years, with pulmonary artery catheters in situ.

Methods

Pulmonary artery wedge pressure (PAWP) and cardiac output measurements in triplicate were taken immediately before, then 1, 5, 15 and 30 min following the infusion of 200 ml of 20% albumin (BPL, Elstree) over a 90 s period. Cardiac index (CI) and left ventricular stroke work index (LVSWI) were calculated for each set of measurements.

Results and statistical analyses

See table.

Conclusion

Cardiac output and left ventricular stroke work were improved in this group of septic patients following the administration of 200 ml of 20% albumin. This suggests that septic patients are normally below their optimal filling pressures, and that the administration of this albumin bolus does not overload them.

Table