Stroke, Vol 16, 790-795, Copyright © 1985 by American Heart Association
JC Grotta, LC Pettigrew, S Allen, A Tonnesen, FM Yatsu, J Gray and J Spydell
Hemodynamic data were obtained in 9 patients (mean age 65 yrs) with carotid
territory cerebral infarct within the preceding 24 hours (mean 14 +/- 8) as
part of a pilot study testing the feasibility and safety of hypervolemic
hemodilution. Pulmonary arterial catheters (PACs) were placed without
complication in all patients, and after baseline measurements were
obtained, up to 1500 cc of 6% hetastarch in 0.9% sodium chloride was
administered the first day and up to 1000 cc per day the second and third
days. Pulmonary wedge pressure (PWP) rose from 6.3 +/- 3.5 to 14.4 +/- 3.4
mm Hg (p less than 0.001) without development of congestive heart failure
in any patient. This was accompanied by a drop in hematocrit (Hct) from
40.3 +/- 3.4 to 32.9 +/- 2.0 (p less than 0.001) and rise in cardiac output
(CO) from 4.3 +/- 1.0 to 5.3 +/- 0.6 (p less than 0.05). Phlebotomy of 250
cc was performed in 2 patients and 500 cc in one in order to reduce Hct to
desired levels. The volume of fluid needed to raise PWP to 15 was
unpredictable (2361 +/- 1106 cc) and therefore PACs were necessary to
monitor the rate and volume of fluid administration. The data show that PWP
is sufficiently low and Hct sufficiently high following stroke in most
patients that hemodilution by volume expansion with phlebotomy added if
necessary can be undertaken safely with appropriate monitoring of
hemodynamic function, and that this therapy results in optimal reduction of
Hct and increased CO without risk of hypotension.
ARTICLES
Baseline hemodynamic state and response to hemodilution in patients with acute cerebral ischemia
This article has been cited by other articles:
 |
|
 |
|
  L. E. Allport, M. W. Parsons, K. S. Butcher, L. MacGregor, P. M. Desmond, B. M. Tress, and S. M. Davis Elevated hematocrit is associated with reduced reperfusion and tissue survival in acute stroke Neurology, November 8, 2005; 65(9): 1382 - 1387. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Bhalla, C.D.A. Wolfe, and A.G. Rudd Management of acute physiological parameters after stroke QJM, March 1, 2001; 94(3): 167 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sinha and E.A. Warburton The evolution of stroke units--towards a more intensive approach? QJM, September 1, 2000; 93(9): 633 - 638. [Full Text] [PDF]
|
|
|
|
|
|
S. A. Mayer, J. Lin, S. Homma, R. A. Solomon, L. Lennihan, D. Sherman, M. E. Fink, A. Beckford, and L. M. Klebanoff Myocardial Injury and Left Ventricular Performance After Subarachnoid Hemorrhage Stroke, April 1, 1999; 30(4): 780 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. R. Wechsler Analytic Reviews : Potential New Therapies for Acute Ischemic Stroke J Intensive Care Med, September 1, 1988; 3(5): 258 - 264. [Abstract] [PDF]
|
|
|
|
 |
|
 G. Ciuffetti, M. Mercuri, L. Parnetti, G. Lupattelli, and U. Senin Hemorheologic Factors in the Postacute Phase of Ischemic Stroke Angiology, May 1, 1988; 39(5): 437 - 448. [Abstract] [PDF]
|
|
|
|
|
|
J. H. Wood and D. B. Kee JR Analytic Reviews : Hypervolemic Hemodilution in Acute Ischemic Stroke J Intensive Care Med, May 1, 1987; 2(3): 126 - 136. [Abstract] [PDF]
|
|