Neurocritical Care

, 15:270

Monitoring of Volume Status After Subarachnoid Hemorrhage

  • Daryl R. Gress
  • The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage


Hypovolemia is common after subarachnoid hemorrhage, and fluid imbalance negatively affects clinical outcome. Standard bedside volume measures fail to adequately assess fluid status after subarachnoid hemorrhage. An electronic literature search of original research studies evaluating fluid status after subarachnoid hemorrhage was conducted for English language articles published through October 2010. Sixteen articles were included in this review, with seven articles produced by two research groups. These studies highlight that fluid status is often affected and difficult to assess after subarachnoid hemorrhage. Both non-invasive and invasive monitors may be used to more accurately define volume status.


Blood volume Hypovolemia Hypervolemia Normovolemia Transpulmonary thermodilution Ultrasound 


  1. 1.
    Wijdicks EF, Vermeulen M, Hijdra A, van Gijn J. Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful? Ann Neurol. 1985;17:137–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Wijdicks EF, Vermeulen M, ten Haaf JA, Hijdra A, Bakker WH, van Gijn J. Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm. Ann Neurol. 1985;18:211–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Diringer MN, Wu KC, Verbalis JG, Hanley DF. Hypervolemic therapy prevents volume contraction but not hyponatremia following subarachnoid hemorrhage. Ann Neurol. 1992;31:543–50.PubMedCrossRefGoogle Scholar
  4. 4.
    Levy ML, Rabb CH, Zelman V, Giannotta SL. Cardiac performance enhancement from dobutamine in patients refractory to hypervolemic therapy for cerebral vasospasm. J Neurosurg. 1993;79:494–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Rosenwasser RH, Jallo JI, Getch CC, Liebman KE. Complications of Swan-Ganz catheterization for hemodynamic monitoring in patients with subarachnoid hemorrhage. Neurosurgery. 1995;37:872–5. discussion 875–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Mori T, Katayama Y, Kawamata T, Hirayama T. Improved efficiency of hypervolemic therapy with inhibition of natriuresis by fludrocortisone in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 1999;91:947–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Lennihan L, Mayer SA, Fink ME, et al. Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: a randomized controlled trial. Stroke. 2000;31:383–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Kasuya H, Onda H, Yoneyama T, Sasaki T, Hori T. Bedside monitoring of circulating blood volume after subarachnoid hemorrhage. Stroke. 2003;34:956–60.PubMedCrossRefGoogle Scholar
  9. 9.
    Mutoh T, Kazumata K, Ajiki M, Ushikoshi S, Terasaka S. Goal-directed fluid management by bedside transpulmonary hemodynamic monitoring after subarachnoid hemorrhage. Stroke. 2007;38:3218–24.PubMedCrossRefGoogle Scholar
  10. 10.
    Hoff RG, Rinkel GJ, Verweij BH, Algra A, Kalkman CJ. Nurses’ prediction of volume status after aneurysmal subarachnoid haemorrhage: a prospective cohort study. Crit Care. 2008;12:R153.PubMedCrossRefGoogle Scholar
  11. 11.
    Hoff RG, van Dijk GW, Algra A, Kalkman CJ, Rinkel GJ. Fluid balance and blood volume measurement after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2008;8:391–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Hoff R, Rinkel G, Verweij B, Algra A, Kalkman C. Blood volume measurement to guide fluid therapy after aneurysmal subarachnoid hemorrhage: a prospective controlled study. Stroke. 2009;40:2575–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Mutoh T, Ishikawa T, Nishino K, Yasui N. Evaluation of the FloTrac uncalibrated continuous cardiac output system for perioperative hemodynamic monitoring after subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2009;21:218–25.PubMedCrossRefGoogle Scholar
  14. 14.
    Mutoh T, Kazumata K, Ishikawa T, Terasaka S. Performance of bedside transpulmonary thermodilution monitoring for goal-directed hemodynamic management after subarachnoid hemorrhage. Stroke. 2009;40:2368–74.PubMedCrossRefGoogle Scholar
  15. 15.
    Hoff RG, Rinkel GJ, Verweij BH, Algra A, Kalkman CJ. Pulmonary edema and blood volume after aneurysmal subarachnoid hemorrhage: a prospective observational study. Crit Care. 2010;14:R43.PubMedCrossRefGoogle Scholar
  16. 16.
    Moretti R, Pizzi B. Inferior vena cava distensibility as a predictor of fluid responsiveness in patients with subarachnoid hemorrhage. Neurocrit Care. 2010;13:3–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Daryl R. Gress
    • 1
  • The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage
  1. 1.Department of NeurologyUniversity of VirginiaCharlottesvilleUSA

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