title: Poor outcome is associated with less negative fluid balance in patients with aneurysmal subarachnoid hemorrhage treated with prophylactic vasopressor-induced hypertension.
abstract: BACKGROUND
  Aneurysmal subarachnoid hemorrhage (SAH) is a serious condition associated with high mortality rates and long-term disability. We investigated the impact of fluid balance on neurologic outcome after adjustment for possible confounders related to intensive care therapy and extra-cerebral organ failure during the early phase after SAH.
  
  
  METHODS
  In this retrospective study, we analyzed data from all 142 adult patients admitted to our university hospital surgical intensive care unit (ICU) with SAH between March 2004 and November 2010.
  
  
  RESULTS
  The mean patient age was 54 ± 14 years, 62.7 % were female, and the median Hunt and Hess score was 3. The proportions of patients with poor outcome (Glasgow Outcome Score ≤3) were 58.4, 54.2, and 52.1 % at 3, 6, and 12 months, respectively, after the SAH. The ICU and hospital mortality rates were both 12.7 %, and the median lengths of stay in the ICU and the hospital were 16 (IQ 7-25) and 26 (IQ 18-34) days, respectively. In multivariable analysis, older age and greater cumulative fluid balance within the first 7 days in the ICU were independently associated with a greater risk of poor outcome.
  
  
  CONCLUSIONS
  In this cohort of patients, older age and greater cumulative fluid balance were independently associated with a greater risk of poor outcome up to 1 year after the initial insult. Our data suggest that mild hypovolemia may be beneficial in the management of these patients.
authors.affiliation: Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Erlanger Allee 101, 07743, Jena, Germany. yasser.sakr@med.uni-jena.de.|Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 101, 07743, Jena, Germany. yasser.sakr@med.uni-jena.de.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.affiliation: Department of Neurosurgery, Uniklinikum Jena, Erlanger Allee 101, 07743, Jena, Germany.
authors.forename: Pedro
authors.initials: P
authors.lastname: Dünisch
authors.affiliation: Department of Intensive Care, Federal University of Espírito Santo, R. Natalina D. Carneiro 874, Vitória, 29060490, Brazil.
authors.forename: Clesar
authors.initials: C
authors.lastname: Santos
authors.affiliation: Department of Neurosurgery, Uniklinikum Jena, Erlanger Allee 101, 07743, Jena, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Matthes
authors.affiliation: Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Erlanger Allee 101, 07743, Jena, Germany.|Department of Anaesthesiology and Intensive Care, Theodor Bilharz Institute, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeidan
authors.affiliation: Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Erlanger Allee 101, 07743, Jena, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.affiliation: Department of Neurosurgery, Uniklinikum Jena, Erlanger Allee 101, 07743, Jena, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kalff
authors.affiliation: Department of Neurosurgery, Uniklinikum Jena, Erlanger Allee 101, 07743, Jena, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ewald
keywords: Negative fluid balance; Outcomes; Subarachnoid hemorrhage