Reduction of pulmonary edema after SAH with a pulmonary artery catheter-guided hemodynamic management protocol.
BACKGROUND
The frequency of pulmonary edema, which occurs with high frequency following subarachnoid hemorrhage (SAH), can be worsened by hypervolemic, hypertensive, hemodilution therapy for vasospasm. This study compares the complication rates for patients with SAH before and after institution of a pulmonary artery catheter-guided hemodynamic management protocol.


METHODS
Complication and outcome data were prospectively collected on 453 patients with spontaneous SAH. The patients were divided into groups treated from July 1998 through January 2000 (n = 174) and from February 2002 through June 2002 (n = 279). In group I, treatment consisted of hypervolemia (central venous pressures: >8 mmHg) and hypertension (mean arterial pressure: 110-130 mmHg). In group II, normovolemia was the goal, defined using a pulmonary artery catheter (wedge pressure: 10-14 mmHg). Cardiac output was enhanced (index: >4.5 L/minute/m2), and blood pressure elevations were moderated (mean pressure: >100 mmHg).


RESULTS
The average age, comorbidity, hemorrhage severity, and incidence of vasospasm were almost identical between the two groups. Statistically significant reductions were noted in patients in group II for two types of complications as well as for mortality. The rate of pulmonary edema (from 14 to 6%) and the rate of sepsis (from 14 to 6%) were both decreased (p <or= 0.03). Mortality decreased from 34 to 29% (p = 0.04). Other complications, such as myocardial infarction, were not affected.


CONCLUSIONS
These data show that a significant reduction in the frequency of pulmonary edema after SAH can be attained using a pulmonary artery catheter-guided hemodynamic management protocol.
Kim
Dong H
DH
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, USA. dkim7@partners.org
Haney
Charles L
CL
Van Ginhoven
Grace
G
D002302:Cardiac Output; D002404:Catheterization; D005260:Female; D006331:Heart Diseases / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery; D011654:Pulmonary Edema / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery / Q000628:therapy*