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Neurocritical Care
Published in: Neurocritical Care 3/2008

01-06-2008 | Original Article

Fluid Balance and Blood Volume Measurement after Aneurysmal Subarachnoid Hemorrhage

Authors: Reinier G. Hoff, Gert W. van Dijk, Ale Algra, Cor J. Kalkman, Gabriel J. E. Rinkel

Published in: Neurocritical Care | Issue 3/2008

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Abstract

Background

Patients with aneurysmal subarachnoid hemorrhage (SAH) are at risk for circulatory volume depletion, which is a risk factor for delayed cerebral ischemia (DCI). In a prospective observational study we assessed the effectiveness of fluid administration based on regular evaluation of the fluid balance in maintaining normovolemia.

Methods

A total of 50 patients with aneurysmal SAH were included and were treated according to a standard protocol aimed at maintaining normovolemia. Fluid intake was adjusted on the basis of the fluid balance, which was calculated at 6-h intervals. Circulating blood volume (CBV) was measured by means of pulse dye densitometry (PDD) on alternating days during the first 2 weeks after SAH.

Results

Of the 265 CBV measurements, 138 (52%) were in the normovolemic range of 60–80 ml/kg; 76 (29%) indicated hypovolemia with CBV < 60 ml/kg; and 51 (19%) indicated hypervolemia with CBV > 80 ml/kg. There was no association between CBV and daily fluid balance (regression coefficient β = −0.32; 95% CI: −1.81 to 1.17) or between CBV and a cumulative fluid balance, adjusted for insensible loss through perspiration and respiration (β = 0.20; 95% CI: −0.31 to 0.72).

Conclusion

Calculations of fluid balance do not provide adequate information on actual CBV after SAH, as measured by PDD. This raises doubt whether fluid management guided by fluid balances is effective in maintaining normovolemia.
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Metadata
Title
Fluid Balance and Blood Volume Measurement after Aneurysmal Subarachnoid Hemorrhage
Authors
Reinier G. Hoff
Gert W. van Dijk
Ale Algra
Cor J. Kalkman
Gabriel J. E. Rinkel
Publication date
01-06-2008
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 3/2008
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-007-9043-x

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