title: Haemodynamic augmentation in the treatment of vasospasm in aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Hypertension, hypervolemia and hemodilution therapy is a common approach to cerebral vasospasm after subarachnoid haemorrhage. This study is designed to see the difference of moderate or aggressive hypervolemia supported with induced hypertension in symptomatic vasospasm detected with transcranial Doppler ultrasonography (TCD) measurements.
  
  
  METHODS
  Fifty eight patients who had aneurysm clipping and were admitted to the neurointensive care unit were treated with normovolemia and induced hypertension (n=35) or hypervolemia supported with induced hypertension (n=23) targeting a mean arterial pressure of 110-130 mm Hg and central venous pressure of 8-12 mm Hg. Daily TCD, fluid intake, fluid balance and haemodynamic values were recorded for 14 days.
  
  
  RESULTS
  There were no differences detected in mean arterial pressure, central venous pressure, hematocrit values, fluid balance and middle cerebral artery flow velocities between the two groups through 14 days (p > 0.05). Hyponatremia, pulmonary edema and cerebral ischemia were observed as complications.
  
  
  CONCLUSIONS
  Hypervolemia adds no benefit compared to normovolemia in the treatment of vasospasm occurred as a result of subarachnoid hemorrhage. Induced hypertension establishes the haemodynamic augmentation to prevent and treat vasospasm.
authors: M.H. Istanbul Medeniyet University, Goztepe Education and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey. melekgura@gmail.com
authors: Melek
authors: M
authors: Gura
authors: Ilhan
authors: I
authors: Elmaci
authors: Ajlan
authors: A
authors: Cerci
authors: Esra
authors: E
authors: Sagiroglu
authors: K Kenan
authors: KK
authors: Coskun
mesh_terms: D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001809:Blood Viscosity; D002496:Central Venous Pressure / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006400:Hematocrit; D006438:Hemodilution / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D020896:Hypovolemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D010952:Plasma Substitutes / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D017585:Ultrasonography, Doppler, Transcranial; D014661:Vasoconstriction / Q000502:physiology; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D014882:Water-Electrolyte Balance
chemical_list: D010952:Plasma Substitutes