Albumin/fluids and svr

Specialties CCU

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Specializes in ICU-CCRN, CVICU, SRNA.

Ok, open heart RN's. Does Albumin increase SVR? Do isotonic solutions increase SVR? I was under the thinking that Albumin does, but was assured otherwise. Thank you guys and girls:)

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Specializes in CVICU.

Depends on what kind of hemodynamic state your patient is in at the time.

Vasodilated - filling the tank with albumin or crystalloids would increase SVR.

Hypovolemic - SVR likely high to start with so then you give fluids or albumin which increases your CO and decreases your SVR.

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Specializes in ICU-CCRN, CVICU, SRNA.

Thank you.

My patient had very low SVR-so likely vasodilatated. I figured some albumin would bump the svr, but some people disagreed. Eventualy levo fixed the issue.

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Specializes in Dialysis.

Any PA numbers to throw into the equation? CO/CI?

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Specializes in ICU-CCRN, CVICU, SRNA.

Well co was high-but I figured its due to the low svr. CO was arround 8-9/index in the 4 range. SVR in the 450-550. pas were ok 30's over 15-18. he did get lasix at end of surgery and put out 1500 in the first 2 hours. my thinking is that he is too dilated and that he could use some albumin to increase svr. Some people disagreed because of the high CO. Anyways, levophed fixed the svr within seconds but its not a standard post-op for our unit.

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Specializes in Dialysis.

With PAD 15-18 the tank is full. At some point albumin might have helped but you would have pushed the filling pressures higher and off of Starling's curve. CO was OK so contractility isn't the issue. If the SVR was 400 the resistance needs to be increased and levophed makes sense. The fact he received lasix with some diuresis makes me think his PA pressures were even higher during surgery.

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Specializes in CVICU.

Some of our surgeons would have done the same thing. Since you had just lost 1500 cc's of fluid it certainly couldnt hurt to give a little back. Chisca is right that what was really needed was an svr. We probably would've used a neo gtt first since you really didnt need the beta1 effects of the norepi. And just for discussion, always gotta remember the pitfalls of using PAd as an indicator of LVEDP. Can be highly inaccurate with many conditions, mitral regurg or stenosis for example.

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Specializes in CT-ICU.

yea similar things happen here, most of the docs attribute it to SVR syndrome or SIRS (systemic inflamatory response) from being on pump. So you'll see wicked high CI/CO, super low SVR. We hardly use levophed here, we usually start a little vaso and/or neo to give them more vascular tone.

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Specializes in Cardiac Critical Care.
Ok, open heart RN's. Does Albumin increase SVR? Do isotonic solutions increase SVR? I was under the thinking that Albumin does, but was assured otherwise. Thank you guys and girls:)

Well co was high-but I figured its due to the low svr. CO was arround 8-9/index in the 4 range. SVR in the 450-550. pas were ok 30's over 15-18. he did get lasix at end of surgery and put out 1500 in the first 2 hours. my thinking is that he is too dilated and that he could use some albumin to increase svr. Some people disagreed because of the high CO. Anyways, levophed fixed the svr within seconds but its not a standard post-op for our unit.

We give albumin as an VOLUME EXPANDER so if pt is hypoalbuminaemic & hypovolemic, meaning hypotension, SVR within norm limits, low urine output then Albumin would help. When someone has an low SVR they are vasodialated. Giving volume wont help much because volume isn't the problem VASCULAR TONE is. Levo is a vaso constrictor and will tighten up the SVR. If someone is too vasoconstricted and their BP and SVR is high we either start SNP, give hydralazine, Lopressor etc to vaso dialate them.

Our patient's if having labile pressures will come up from the OR on either Levo or Nipride to control pressures. Most of the times its part of the post op orders. If not we call the docs and they may order if indicated. If they don't come up on it we mix our own bags and start titrating. Once pt is stable we my initiate therapies to wean from vasopressors.

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Specializes in Cardiac, Derm, OB.

Usually with Levo a little fluid is not a bad thing. It doesn't help to "tighten everything up" if there is not sufficient "fluid" in lines.

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Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.

Where are you getting the idea that svr is affected by albumin? Albumin is a volume expander. It increases oncotic pressure which will hold or draw fluid in the vasculature.

Please correct me if I am missing something here

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SVR is only a calculated number

Resistance = Pressure Gradient / Flow

Any interventions that increase mean perfusion pressure (MAP - CVP) or decrease CO will mathematically increase the SVR number.

Giving fluid will have multiple effects- small inc in CVP, inc LV preload so inc CO at the same HR, barereceptor response to inc BP.... all these factors determine the ratio which will result in the SVR calcuation.

So in a mathematical sense, volume will inc SVR under certain circumstances. But at the bedside most folks use SVR to refer to drug mediated vascular tone. Post pump vasodilation is the most common cause, which is treated with pressors (neo/vaso/levo/dopa etc) as long as there is adequate preload.

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