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Correction of hypocalcaemia in the critically ill: what is the haemodynamic benefit?
J L Vincent1, P Bredas, S Jankowski
1Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Insights
Calcium repletion in critically ill patients with hypocalcaemia significantly increased arterial pressure and improved left ventricular function. However, cardiac index and oxygen delivery did not show significant changes.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
- Electrolyte Balance
Background:
- Hypocalcaemia is common in critically ill patients.
- The cardiovascular benefits of calcium repletion in this population are not well-defined.
Purpose of the Study:
- To prospectively assess the cardiovascular response to calcium administration in critically ill patients with hypocalcaemia.
Main Methods:
- 17 invasively monitored ICU patients with ionized hypocalcaemia (Ca2+ < 1.05 mmol/l) received slow intravenous calcium chloride (1 g).
- Cardiovascular parameters including mean arterial pressure, cardiac filling pressures, heart rate, cardiac index, systemic vascular resistance, and left ventricular stroke work index were monitored.
Main Results:
- Calcium administration significantly increased mean arterial pressure (77 to 90 mmHg, P < 0.01) and left ventricular stroke work index (23 to 32 g.m/m2, P < 0.01).
- No significant changes were observed in cardiac filling pressures or heart rate.
- Slight, non-significant increases in cardiac index and systemic vascular resistance were noted.
Conclusions:
- Correction of hypocalcaemia can significantly improve arterial pressure and left ventricular function in critically ill patients.
- These hemodynamic improvements persist for at least 1 hour.
- Cardiac index and oxygen delivery do not significantly increase despite calcium repletion.
Objective:
The prevalence of hypocalcaemia is known to be elevated in critically ill patients, but the expected benefit from calcium repletion in hypocalcaemic patients has not been well defined. The objective of the present study was therefore prospective determination of the cardiovascular response to calcium administration in critically ill patients with hypocalcaemia.
Patients:
A total of 17 patients found to have ionized hypocalcaemia (Ca2+ < 1.05 mmol/l) from a group of 32 patients who were invasively monitored as part of their ICU management.
Intervention:
Slow intravenous injection of 1 g of calcium chloride.
Measurements And Results:
Calcium administration was followed by an increase in mean arterial pressure from 77 +/- 8 to 90 +/- 12 mmHg (P < 0.01). There was no significant change in cardiac filling pressures or heart rate. Cardiac index and systemic vascular resistance increased slightly but not significantly (from 2.67 +/- 0.92 to 2.81 +/- 1.25 1/min.m2 and from 2133 +/- 647 to 2378 +/- 817 dynes.s.cm-5 m-2, respectively). Left ventricular stroke work index increased from 23 +/- 8 to 32 +/- 13 g.m/m2 (P < 0.01). These changes were maintained for 60 min.
Conclusions:
The correction of hypocalcaemia can result in a significant increase in arterial pressure that can persist for at least 1 h. Despite an associated improvement in left ventricular function, cardiac index and oxygen delivery do not increase significantly.