What question did this study set out to answer?

To assess hemodynamic responses to graded fluid resuscitation and identify the optimal fluid volume required to restore and maintain systolic blood pressure ≥90 mmHg in patients with inferior wall myocardial infarction complicated by right ventricular myocardial infarction.

May 1, 2021Heart IndiaOpen Access

Invasive assessment of fluid therapy in hypotensive patients of postinferior wall myocardial infarction complicated by right ventricular infarction

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Why the study?

Does graded fluid infusion improve hemodynamic parameters in hypotensive patients with inferior wall myocardial infarction complicated by right ventricular infarction?

Population

16 patients with first episode of acute coronary syndrome with IWMI, RVMI, and SBP <90 mmHg

Comparison

Graded fluid infusion of 500 ml normal saline over 15 min until SBP ≥ 90 mmHg

Design

Single-center prospective observational study

Authors

SVSameer VankarKing George's Medical University ASAkhil SharmaCentral University of Himachal Pradesh SDS. DwivediKing George's Medical University

Discussion

Member takes

Implication

Graded fluid infusion may aid hemodynamics in hypotensive IWMI-RVMI; leaves open optimal volumes for randomized confirmation.

Key Points

To assess hemodynamic responses to graded fluid resuscitation and identify the optimal fluid volume required to restore and maintain systolic blood pressure ≥90 mmHg in patients with inferior wall myocardial infarction complicated by right ventricular myocardial infarction.
Conducted a single-center, prospective observational study evaluating 16 patients with inferior wall myocardial infarction complicated by right ventricular myocardial infarction presenting with systolic blood pressure <90 mmHg (3 patients excluded, 13 treated).
Administered graded 500 mL normal saline infusions over 15-minute intervals under invasive monitoring until systolic blood pressure reached ≥90 mmHg, measuring cardiac output, cardiac index, and pulmonary capillary wedge pressure after each bolus.
Graded fluid therapy significantly elevated cardiac output from 2.1 ± 0.7 to 3.7 ± 0.7 L/min, cardiac index from 1.3 ± 0.3 to 2.4 ± 0.76 L/min/m², and pulmonary capillary wedge pressure from 8.4 ± 3.0 to 17.6 ± 1.5 mmHg compared with baseline.
Achieving a ≥10% rise in cardiac output required an average of 865 ± 462 mL of saline, whereas sustaining systolic blood pressure ≥90 mmHg required 2192 ± 560 mL, with zero occurrences of acute pulmonary edema or in-hospital mortality.

Structured PICO

Does graded fluid infusion improve hemodynamic parameters in hypotensive patients with inferior wall myocardial infarction complicated by right ventricular infarction?

Population

16 patients (13 analyzed) with first episode of acute coronary syndrome diagnosed as inferior wall myocardial infarction (IWMI) complicated by right ventricular myocardial infarction (RVMI) and systolic blood pressure <90 mmHg.

Intervention

Graded fluid infusion of 500 ml normal saline over 15 min until systolic blood pressure ≥ 90 mmHg was attained.

Outcome

Change in cardiac output, cardiac index, and pulmonary capillary wedge pressure (PCWP) with response to fluid; amount of fluid needed for ≥ 10% rise in cardiac output and to maintain SBP ≥ 90 mmHg.surrogate

In hypotensive patients with right ventricular myocardial infarction, graded fluid therapy significantly improves hemodynamic parameters, requiring an average of ~2.2 L of normal saline to maintain systolic blood pressure ≥ 90 mmHg.

Limitations

Small sample size

Cite This Study

Vankar et al. (2021) studied this question.

synapsesocial.com/papers/6a7a644b77336a1bae02c7d5 https://doi.org/10.4103/heartindia.heartindia_90_21

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Invasive assessment of fluid therapy in hypotensive patients of postinferior wall myocardial infarction complicated by right ventricular infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Invasive assessment of fluid therapy in hypotensive patients of postinferior wall myocardial infarction complicated by right ventricular infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider