title: A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage.
abstract: OBJECT Subarachnoid hemorrhage (SAH) is often accompanied by pulmonary complications, which may lead to poor outcomes and death. This study investigated the incidence and cause of pulmonary edema in patients with SAH by using hemodynamic monitoring with PiCCO-plus pulse contour analysis. METHODS A total of 204 patients with SAH were included in a multicenter prospective cohort study to investigate hemodynamic changes after surgical clipping or coil embolization of ruptured cerebral aneurysms by using a PiCCO-plus device. Changes in various hemodynamic parameters after SAH were analyzed statistically. RESULTS Fifty-two patients (25.5%) developed pulmonary edema. Patients with pulmonary edema (PE group) were significantly older than those without pulmonary edema (non-PE group) (p = 0.017). The mean extravascular lung water index was significantly higher in the PE group than in the non-PE group throughout the study period. The pulmonary vascular permeability index (PVPI) was significantly higher in the PE group than in the non-PE group on Day 6 (p = 0.029) and Day 10 (p = 0.011). The cardiac index of the PE group was significantly decreased biphasically on Days 2 and 10 compared with that of the non-PE group. In the early phase (Days 1-5 after SAH), the daily water balance of the PE group was slightly positive. In the delayed phase (Days 6-14 after SAH), the serum C-reactive protein level and the global end-diastolic volume index were significantly higher in the PE group than in the non-PE group, whereas the PVPI tended to be higher in the PE group. CONCLUSIONS Pulmonary edema that occurs in the early and delayed phases after SAH is caused by cardiac failure and inflammatory (i.e., noncardiogenic) conditions, respectively. Measurement of the extravascular lung water index, cardiac index, and PVPI by PiCCO-plus monitoring is useful for identifying pulmonary edema in patients with SAH.
authors.affiliation: Department of Neurosurgery, Tokyo Medical and Dental University;|SAH PiCCO Study Group.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Obata
authors.affiliation: Department of Neurosurgery, Kansai Medical University Takii Hospital, Osaka;|SAH PiCCO Study Group.
authors.forename: Junichi
authors.initials: J
authors.lastname: Takeda
authors.affiliation: Department of Neurosurgery, Tokyo Medical and Dental University;|SAH PiCCO Study Group.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka;|SAH PiCCO Study Group.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ishikura
authors.affiliation: Department of Neurosurgery, Saitama Medical Center, Saitama;|SAH PiCCO Study Group.
authors.forename: Toru
authors.initials: T
authors.lastname: Matsui
authors.affiliation: Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East, Japan; and.|SAH PiCCO Study Group.
authors.forename: Eiji
authors.initials: E
authors.lastname: Isotani
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011652:Pulmonary Circulation; D011654:Pulmonary Edema / Q000453:epidemiology* / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology
keywords: CI = cardiac index; CRP = C-reactive protein; DCI = delayed cerebral ischemia; ELWI = extravascular lung water index; GEDI = global end-diastolic volume index; PVPI = pulmonary vascular permeability index; SAH = subarachnoid hemorrhage; SVRI = systemic vascular resistance index; WFNS = World Federation of Neurosurgical Societies; acute respiratory distress syndrome; extravascular lung water; pulmonary edema; subarachnoid hemorrhage; thermodilution; vascular disorders; vascular permeability