title: Optimal range of global end-diastolic volume for fluid management after aneurysmal subarachnoid hemorrhage: a multicenter prospective cohort study.
abstract: OBJECTIVE
  Limited evidence supports the use of hemodynamic variables that correlate with delayed cerebral ischemia or pulmonary edema after aneurysmal subarachnoid hemorrhage. The aim of this study was to identify those hemodynamic variables that are associated with delayed cerebral ischemia and pulmonary edema after subarachnoid hemorrhage.
  
  
  METHODS
  A multicenter prospective cohort study.
  
  
  METHODS
  Nine university hospitals in Japan.
  
  
  METHODS
  A total of 180 patients with aneurysmal subarachnoid hemorrhage.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patients were prospectively monitored using a transpulmonary thermodilution system in the 14 days following subarachnoid hemorrhage. Delayed cerebral ischemia was developed in 35 patients (19.4%) and severe pulmonary edema was developed in 47 patients (26.1%). Using the Cox proportional hazards model, the mean global end-diastolic volume index (normal range, 680-800 mL/m) was the independent factor associated with the occurrence of delayed cerebral ischemia (hazard ratio, 0.74; 95% CI, 0.60-0.93; p = 0.008). Significant differences in global end-diastolic volume index were detected between the delayed cerebral ischemia and non-delayed cerebral ischemia groups (783 ± 25 mL/m vs 870 ± 14 mL/m; p = 0.007). The global end-diastolic volume index threshold that best correlated with delayed cerebral ischemia was less than 822 mL/m, as determined by receiver operating characteristic curves. Analysis of the Cox proportional hazards model indicated that the mean global end-diastolic volume index was the independent factor that associated with the occurrence of pulmonary edema (hazard ratio, 1.31; 95% CI, 1.02-1.71; p = 0.03). Furthermore, a significant positive correlation was identified between global end-diastolic volume index and extravascular lung water (r = 0.46; p < 0.001). The global end-diastolic volume index threshold that best correlated with severe pulmonary edema was greater than 921 mL/m.
  
  
  CONCLUSIONS
  Our findings suggest that global end-diastolic volume index impacts both delayed cerebral ischemia and pulmonary edema after subarachnoid hemorrhage. Maintaining global end-diastolic volume index slightly above normal levels has promise as a fluid management goal during the treatment of subarachnoid hemorrhage.
authors.affiliation: 1Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan. 2Department of Health Economics and Epidemiology Research, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tagami
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kuwamoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Watanabe
authors.forename: Kyoko
authors.initials: K
authors.lastname: Unemoto
authors.forename: Shoji
authors.initials: S
authors.lastname: Yokobori
authors.forename: Gaku
authors.initials: G
authors.lastname: Matsumoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
mesh_terms: D000328:Adult; D000368:Aged; D001810:Blood Volume / Q000502:physiology*; D015633:Extravascular Lung Water / Q000502:physiology; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D020896:Hypovolemia / Q000517:prevention & control*; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D012372:ROC Curve; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013815:Thermodilution / Q000379:methods