title: The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage.
abstract: OBJECTIVE
  The triple-H therapy is widely used for cerebral vasospasm (CV) prevention and treatment in patients after subarachnoid haemorrhage (SAH). However, this practice is based on low level evidence. Aim of this study was to evaluate errors in fluid administration, fluid balance monitoring and bedside charts completeness during a trial of triple-H therapy.
  
  
  METHODS
  An audit of the SAH patient charts was performed. A total of 508 fluid measurements were performed in 41 patients (6 with delayed cerebral ischaemia; DCI) during 14 days of observation.
  
  
  RESULTS
  Underestimating for intravenous drugs was the most frequent error (80.6%; 112), resulting in a false positive fluid balance in 2.4% of estimations. In 38.6% of the negative fluid balance cases, the physicians did not order additional fluids for the next 24h. In spite of that, the fluid intake was significantly increased after DCI diagnosis. The mean and median intake values were 3.5 and 3.8l/24h respectively, although 40% of the fluid balances were negative. The positive to negative fluid balance ratio was decreasing in the course of the 14 day observation.
  
  
  CONCLUSIONS
  This study revealed inconsistencies in the fluid orders as well as mistakes in the fluid monitoring, which illustrates the difficulties of fluid therapy and reinforces the need for strong evidence-based guidelines for hypervolemic therapy in SAH.
authors.affiliation: Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland. Electronic address: tszmuda@gumed.edu.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Szmuda
authors.affiliation: Students' Scientific Association, Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Przemyslaw M
authors.initials: PM
authors.lastname: Waszak
authors.affiliation: Students' Scientific Association, Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Rydz
authors.affiliation: Students' Scientific Association, Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Springer
authors.affiliation: Students' Scientific Association, Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Budynko
authors.affiliation: Students' Scientific Association, Neurosurgery Department, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Szydlo
authors.affiliation: Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Sloniewski
authors.affiliation: Department of Neurosurgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Dzierżanowski
mesh_terms: D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000517:prevention & control*
keywords: Aneurysmal subarachnoid haemorrhage; Delayed cerebral ischaemia; Intracranial vasospasm; Recommendations adherence; Triple-H therapy