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Title: Haemodynamic effects of cold versus warm fluid bolus in healthy volunteers: a randomised crossover trial.
Austin Authors: Wall, Olof;Ehrenberg, Lars;Joelsson-Alm, Eva;Mårtensson, Johan;Bellomo, Rinaldo ;Svensén, Christer;Cronhjort, Maria
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
Issue Date: Dec-2018
Publication information: Critical Care and Resuscitation 2018; 20(4): 277-284
Abstract: To test the hypothesis that changes in cardiac index and mean arterial pressure (MAP) during and after a fluid bolus (FB) are altered by fluid temperature. Randomised, controlled, crossover trial. Research laboratory at Swedish teaching hospital. Twenty-one healthy adult volunteers. Subjects were randomly allocated to 500 mL of Ringer's acetate at room temperature (22°C; cold) or body temperature (38°C; warm). For 2 hours after starting the FB, we measured cardiac index, MAP, systolic blood pressure, diastolic blood pressure and pulse rate (PR) continuously. We recorded temperature and O2 saturation every 5 minutes during infusion and every 15 minutes thereafter. In a second session, volunteers crossed over. During the first 15 minutes, mean cardiac index increased more with warm FB (0.09 L/min/m2 [95% CI, 0.06-0.11] v 0.03 L/min/m2 [95% CI, 0.01-0.06]; P < 0.001). This effect was mediated by a significant difference in mean PR (+0.80 beats/min [95% CI, 0.47-1.13] v -1.33 beats/ min [95% CI, -1.66 to -1.01]; P < 0.010). In contrast, MAP increased more with cold FB (4.02 mmHg [95% CI, 3.63-4.41] v 0.60 mmHg [95% CI, 0.26-0.95]; P < 0.001). Cardiac index and MAP returned to baseline after a median of 45.3 min (interquartile range [IQR], 10.7-60.7 min) and 27.7 min (IQR, 5.3-105.0 min), respectively, after cold FB, and by 15.8 min (IQR, 3.8-64.3 min) and 22.7 min (IQR, 3.3-105.0 min), respectively, after warm FB. Intravenous FB at body temperature leads to a greater increase in cardiac index compared with room temperature, while the reverse applies to MAP. These findings imply that in healthy volunteers, when a room temperature FB is given, the temperature of the fluid rather than its volume accounts for most of the MAP increase. EudraCT no. 2016-002548-18 and NCT03209271.
ORCID: 0000-0002-1650-8939
PubMed URL: 30482135
ISSN: 1441-2772
Type: Journal Article
Appears in Collections:Journal articles

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