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Fluid Balance and Blood Volume Measurement after Aneurysmal Subarachnoid Hemorrhage

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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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Acknowledgments

This study was supported by a grant of ZonMw—the Netherlands Organisation for Health Research and Development (project number 945-05-035) and by the Department of Perioperative & Emergency Care, University Medical Center Utrecht, the Netherlands.

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Authors and Affiliations

  1. Rudolf Magnus Institute of Neuroscience, Department of Perioperative and Emergency Care, Q 04.2.303, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, The Netherlands

    Reinier G. Hoff & Cor J. Kalkman

  2. Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands

    Gert W. van Dijk, Ale Algra & Gabriel J. E. Rinkel

  3. Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    Gert W. van Dijk

  4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Ale Algra

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  1. Reinier G. Hoff
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  2. Gert W. van Dijk
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  5. Gabriel J. E. Rinkel
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Correspondence to Reinier G. Hoff.

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Hoff, R.G., van Dijk, G.W., Algra, A. et al. Fluid Balance and Blood Volume Measurement after Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 8, 391–397 (2008). https://doi.org/10.1007/s12028-007-9043-x

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