title: Bedside monitoring of circulating blood volume after subarachnoid hemorrhage.
abstract: OBJECTIVE
  Maintenance of an adequate intravascular volume is important in the management of patients with subarachnoid hemorrhage (SAH). The purpose of this study was to investigate the circulating blood volume (CBV) after SAH with the use of indocyanine green pulse spectrophotometry.
  
  
  METHODS
  CBV and plasma hormones related to stress and fluid regulation were measured 4 times: day 2 to 3, day 4 to 5, day 7 to 8, and day 14 in 50 consecutive patients with SAH surgically treated within 48 hours.
  
  
  RESULTS
  The mean value of CBV was 64 mL/kg on day 2 to 3, which gradually increased to 69 mL/kg on day 4 to 5, 71 mL/kg on day 7 to 8, and 70 mL/kg on day 14 (P=0.005) (control, 72 mL/kg). The clinical grades and plasma corticotropin levels were higher in patients with <60 mL/kg of CBV on day 2 to 3 (P<0.05 for both). There were no significant differences in other physiological and laboratory parameters such as time for surgery, estimated blood loss, levels of plasma noradrenaline, brain natriuretic peptide, serum sodium, and hematocrit. When CBV was decreased >10% of the former level, there were decreases in hematocrit (P<0.05), serum sodium (P<0.01), and serum albumin (P<0.05) and an increase in urinary sodium (P<0.05).
  
  
  CONCLUSIONS
  A significant reduction of CBV, especially in patients with poor clinical grades, was noted after SAH and early surgery, which could not be detected by routine examinations. Anemia, central salt wasting, and hypoalbuminemia may be related to a decrease in CBV from the former level. Indocyanine green pulse spectrophotometry may be a powerful tool for the management of patients with SAH.
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Japan. hkasuya@nij.twmu.ac.jp
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kasuya
authors.forename: Hideaki
authors.initials: H
authors.lastname: Onda
authors.forename: Taku
authors.initials: T
authors.lastname: Yoneyama
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sasaki
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
mesh_terms: D001811:Blood Volume Determination; D002560:Cerebrovascular Circulation; D004396:Coloring Agents; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis*; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019095:Point-of-Care Systems; D011184:Postoperative Period; D013053:Spectrophotometry; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000601:surgery
chemical_list: D004396:Coloring Agents; D006728:Hormones; D007208:Indocyanine Green