High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output-Guided Fluid Restriction
Vergouw, Leonie J M; Egal, Mohamud; Bergmans, Bas; Dippel, Diederik W J; Lingsma, Hester F; Vergouwen, Mervyn D I; Willems, Peter W A; Oldenbeuving, Annemarie W; Bakker, Jan; van der Jagt, Mathieu
(2020) Journal of Intensive Care Medicine, volume 35, issue 2, pp. 161 - 169
(Article)
Abstract
BACKGROUND: Guidelines on the management of aneurysmal subarachnoid hemorrhage (aSAH) recommend euvolemia, whereas hypervolemia may cause harm. We investigated whether high early fluid input is associated with delayed cerebral ischemia (DCI), and if fluid input can be safely decreased using transpulmonary thermodilution (TPT). METHODS: We retrospectively included aSAH patients treated
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at an academic intensive care unit (2007-2011; cohort 1) or managed with TPT (2011-2013; cohort 2). Local guidelines recommended fluid input of 3 L daily. More fluids were administered when daily fluid balance fell below +500 mL. In cohort 2, fluid input in high-risk patients was guided by cardiac output measured by TPT per a strict protocol. Associations of fluid input and balance with DCI were analyzed with multivariable logistic regression (cohort 1), and changes in hemodynamic indices after institution of TPT assessed with linear mixed models (cohort 2). RESULTS: Cumulative fluid input 0 to 72 hours after admission was associated with DCI in cohort 1 (n=223; odds ratio [OR] 1.19/L; 95% confidence interval 1.07-1.32), whereas cumulative fluid balance was not. In cohort 2 (23 patients), using TPT fluid input could be decreased from 6.0 ± 1.0 L before to 3.4 ± 0.3 L; P = .012), while preload parameters and consciousness remained stable. CONCLUSION: High early fluid input was associated with DCI. Invasive hemodynamic monitoring was feasible to reduce fluid input while maintaining preload. These results indicate that fluid loading beyond a normal preload occurs, may increase DCI risk, and can be minimized with TPT.
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Keywords: aneurysmal subarachnoid hemorrhage, delayed cerebral ischemia, fluid management, hypervolemia, transpulmonary thermodilution, Critical Care and Intensive Care Medicine, Journal Article
ISSN: 0885-0666
Publisher: SAGE Publications Inc.
Note: Funding Information: The authors thank Dr J. Horn, Academic Medical Center, Amsterdam, and Dr P. J. W. Dennesen, Medisch Centrum Haaglanden, The Hague, the Netherlands, for their collection of data and contributions to an earlier version of the manuscript. They also thank Dr W. J. R. Rietdijk for his advice concerning the statistical analyses for cohort 2. The author(s) received no financial support for the research, authorship, and/or publication of this article. Publisher Copyright: © The Author(s) 2017. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
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