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

• Published in: Journal of applied physiology (1985) Vol. 119; no. 7; pp. 783 - 792
• Main Authors: Bihari, Shailesh, Wiersema, Ubbo F., Schembri, David, De Pasquale, Carmine G., Dixon, Dani-Louise, Prakash, Shivesh, Lawrence, Mark D., Bowden, Jeffrey J., Bersten, Andrew D.
• Format: Journal Article
• Language: English
• Published: United States American Physiological Society 01.10.2015
• Subjects: Adult; Albumins; Angiopoietin-2 - blood; Blood Volume; Cardiac Output; Cross-Over Studies; Double-Blind Method; Edema; Glucose; Glucose Solution, Hypertonic; Healthy Volunteers; Humans; Infusions, Intravenous; Lung Volume Measurements; Lungs; Male; Males; Natriuretic Peptide, Brain - blood; Plasma; Pulmonary Edema - chemically induced; Pulmonary Edema - diagnostic imaging; Respiratory Mechanics; Saline water; Sodium Chloride; Solutions; Ultrasonography; Young Adult; cardiac output; pulmonary edema; 0.9% saline; 5% glucose; 4% albumin; ultrasound
• ISSN: 8750-7587; 1522-1601; 1522-1601
• DOI: 10.1152/japplphysiol.00356.2015

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 (DL CO ), 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 DL CO , 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.