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(Stroke. 2009;40:2575.)
© 2009 American Heart Association, Inc.

Research Letters

Blood Volume Measurement to Guide Fluid Therapy After Aneurysmal Subarachnoid Hemorrhage

A Prospective Controlled Study

Reinier Hoff, MD; Gabriel Rinkel, MD; Bon Verweij, MD; Ale Algra, MD Cor Kalkman, MD

From the Departments of Perioperative & Emergency Care (R.H., C.K.), Neurology (G.R., A.A.), and Neurosurgery (B.V.), Rudolf Magnus Institute of Neuroscience, and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands.

Correspondence to Reinier Hoff, Anesthesiologist-Intensivist, Department of Perioperative & Emergency Care, Q 04.2.303, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail r.hoff{at}umcutrecht.nl

Background and Purpose— Conventional parameters used to guide fluid therapy after aneurysmal subarachnoid hemorrhage (SAH) are poorly related to blood volume. In a prospective controlled study we assessed whether fluid management guided by daily measurements of blood volume (BV) reduces the incidence of severe hypovolemia compared to conventional fluid balance guided fluid therapy.

Methods— We used Pulse Dye Densitometry to measure BV daily in 102 patients during the first 10 days after SAH. Fluid management was based on BV-measurements in the intervention group (n=54) and on fluid balance in the control group (n=48). Severe hypovolemia was defined as BV <50 mL/kg.

Results— In the intervention group 6.7% of BV measurements were in the severe hypovolemic range and in the control group 17.1% (mean weighted difference 7.7%; 95% CI: 1.4 to 13.9%). In the intervention group 21 patients (39%) had 1 or more measurements with severe hypovolemia versus 26 (54%) of the controls (RR 0.7; 95% CI: 0.5 to 1.1).

Conclusions— Guiding fluid management on daily measurements of blood volume reduces the incidence of severe hypovolemia after SAH. The effects on neurological outcome should be studied.

Key Words: aneurysm • brain ischemia • cerebrovascular disease • hemodynamics • subarachnoid hemorrhage • blood volume