Calcium chloride administration in normocalcemic critically ill patients

Ten normocalcemic critically ill patients who had experienced a decrease in cardiac index greater than or equal to 0.5 liter/min/m2 after incremental changes of PEEP received 7 mg/kg of CaCl2 as a slow iv bolus, followed by an infusion of 20 mg/kg CaCl2 over 60 min. Hemodynamic pressures and flow, oxygen uptake and transport, and blood chemistry variables were determined over a 120-min period. The results indicated that: (1) hemodynamic variables were not affected except for left ventricular stroke work index and mean blood pressure, which increased slightly; (2) both serum calcium and ionized calcium concentrations increased significantly, sometimes to dangerous levels; (3) colloid osmotic pressure and hemoglobin levels decreased slightly but consistently. In conclusion, CaCl2 administration failed to improve hemodynamic function depressed by PEEP. If CaCl2 can play a relevant role in the management of cardiovascular depression, further identification of appropriate doses and patients is necessary.