title: Global end-diastolic volume is associated with the occurrence of delayed cerebral ischemia and pulmonary edema after subarachnoid hemorrhage.
abstract: Predictive variables of delayed cerebral ischemia (DCI) and pulmonary edema following subarachnoid hemorrhage (SAH) remain unknown. We aimed to determine associations between transpulmonary thermodilution-derived variables and DCI and pulmonary edema occurrence after SAH. We reviewed 34 consecutive SAH patients monitored by the PiCCO system. Six patients developed DCI at 7 days after SAH on average; 28 did not (non-DCI). We compared the variable measures for 1 day before DCI occurred (DCI day -1) in the DCI group and 6 days after SAH (non-DCI day -1) in the non-DCI group for control. The mean value of the global end-diastolic volume index (GEDI) for DCI day -1 was lower than that for non-DCI day -1 (676 ± 65 vs. 872 ± 85 mL/m, P = 0.04). Central venous pressure (CVP) was not significantly different (7.8 ± 3.1 vs. 9.4 ± 1.9 cm H2O, P = 0.45). At day -1 for both DCI and non-DCI, 11 patients (32%) had pulmonary edema. Global end-diastolic volume index was significantly higher in patients with pulmonary edema than in those without this condition (947 ± 126 vs. 766 ± 81 mL/m, P = 0.02); CVP was not significantly different (8.7 ± 2.8 vs. 9.2 ± 2.1 cm H2O, P = 0.78). Although significant correlation was found between extravascular lung water (EVLW) measures and GEDI (r = 0.58, P = 0.001), EVLW and CVP were not correlated (r = 0.03, P = 0.88). Thus, GEDI might be associated with DCI occurrence and EVLW accumulation after SAH.
authors: Departments of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors: Akihiro
authors: A
authors: Watanabe
authors: Takashi
authors: T
authors: Tagami
authors: Shoji
authors: S
authors: Yokobori
authors: Gaku
authors: G
authors: Matsumoto
authors: Yutaka
authors: Y
authors: Igarashi
authors: Go
authors: G
authors: Suzuki
authors: Hidetaka
authors: H
authors: Onda
authors: Akira
authors: A
authors: Fuse
authors: Hiroyuki
authors: H
authors: Yokota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology*; D002302:Cardiac Output; D002496:Central Venous Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology*; D013815:Thermodilution