on May 7, 2009
Published online before print May 7, 2009, doi: 10.1161/STROKEAHA.108.538116
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Submitted on September 24, 2008
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. * To whom correspondence should be addressed. 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.
Accepted on December 15, 2008
Blood Volume Measurement to Guide Fluid Therapy After Aneurysmal Subarachnoid Hemorrhage. A Prospective Controlled Study
Reinier Hoff MD*;
Key words: aneurysm • brain ischemia • cerebrovascular disease • hemodynamics • subarachnoid hemorrhage • blood volume