title: Impact of clipping versus coiling on postoperative hemodynamics and pulmonary edema after subarachnoid hemorrhage.
abstract: Volume management is critical for assessment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). This multicenter prospective cohort study compared the impact of surgical clipping versus endovascular coiling on postoperative hemodynamics and pulmonary edema in patients with SAH. Hemodynamic parameters were measured for 14 days using a transpulmonary thermodilution system. The study included 202 patients, including 160 who underwent clipping and 42 who underwent coiling. There were no differences in global ejection fraction (GEF), cardiac index, systemic vascular resistance index, or global end-diastolic volume index between the clipping and coiling groups in the early period. However, extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were significantly higher in the clipping group in the vasospasm period. Postoperative C-reactive protein (CRP) level was higher in the clipping group and was significantly correlated with postoperative brain natriuretic peptide level. Multivariate analysis found that PVPI and GEF were independently associated with high EVLWI in the early period, suggesting cardiogenic edema, and that CRP and PVPI, but not GEF, were independently associated with high EVLWI in the vasospasm period, suggesting noncardiogenic edema. In conclusion, clipping affects postoperative CRP level and may thereby increase noncardiogenic pulmonary edema in the vasospasm period. His trial is registered with University Hospital Medical Information Network UMIN000003794.
authors.affiliation: Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Horie
authors.affiliation: Department of Neurosurgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Iwaasa
authors.affiliation: Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi-Ogu, Arakawa-ku, Tokyo 116-8567, Japan.
authors.forename: Eiji
authors.identifier: 0000-0002-2294-1800
authors.initials: E
authors.lastname: Isotani
authors.affiliation: Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Ishizaka
authors.affiliation: Department of Neurosurgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D002199:Capillary Permeability; D015633:Extravascular Lung Water; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology*; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology*; D013318:Stroke Volume; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology*; D013525:Surgical Instruments; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000503:physiopathology
chemical_list: D002097:C-Reactive Protein