From the Guidelines
Fluids can be given to patients with pulmonary embolism (PE), but cautious volume loading with less than 500 mL over 15-30 minutes is recommended. The management of fluids in PE patients requires careful consideration to avoid worsening right ventricular strain and potentially increasing pulmonary pressures. According to the 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism 1, volume optimization with cautious volume loading using saline or Ringer’s lactate is a recommended strategy for treating right ventricular failure in acute high-risk pulmonary embolism.
Key considerations for fluid management in PE include:
- Using isotonic crystalloids like normal saline or lactated Ringer's solution
- Administering fluids judiciously, typically at maintenance rates or with slight restriction
- Avoiding aggressive fluid administration to prevent volume overloading the right ventricle
- Monitoring patients closely for signs of right heart failure, such as jugular venous distention, peripheral edema, or worsening hypoxemia
- Individualizing fluid management based on the patient's hemodynamic status
The goal of fluid management in PE is to maintain adequate preload to support cardiac output without exacerbating right ventricular dysfunction. As noted in the guidelines 1, volume loading can over-distend the RV, worsen ventricular interdependence, and reduce cardiac output, highlighting the need for cautious fluid administration.
From the Research
Administration of Fluids with Pulmonary Embolism (PE)
- The administration of fluids in patients with pulmonary embolism (PE) should be approached with caution, as it can have both positive and negative effects on the patient's condition 2.
- Fluids should only be given if there is concern for hypovolemia and absence of right ventricular (RV) dilatation, as indicated in the management of acute PE 2.
- The use of IV fluids, such as crystalloids, may be considered in patients with hypovolemia, but the choice of fluid should be individualized based on the patient's specific needs and clinical conditions 3.
- In patients with PE, the primary goal is to optimize right ventricle (RV) function, and fluid administration should be guided by this principle 2.
Considerations for Fluid Administration
- The presence of RV dysfunction or volume overload should be assessed before administering fluids, and IV loop diuretics may be useful in these cases 2.
- The use of positive pressure ventilation should be avoided if possible, as it can exacerbate RV dysfunction in patients with PE 2.
- The management of PE should be tailored to the individual patient's needs, taking into account their clinical presentation, risk factors, and comorbidities 4, 5, 6.