Blood volume measurement to guide fluid therapy after aneurysmal subarachnoid hemorrhage: a prospective controlled study.
OBJECTIVE
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.
Hoff
Reinier
R
Department of Perioperative & Emergency Care, University Medical Center Utrecht, Utrecht, The Netherlands. r.hoff@umcutrecht.nl
Rinkel
Gabriel
G
Verweij
Bon
B
Algra
Ale
A
Kalkman
Cor
C
D000328:Adult; D000368:Aged; D001810:Blood Volume / Q000502:physiology; D001811:Blood Volume Determination / Q000379:methods*; D003720:Densitometry; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D020896:Hypovolemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*