Abstract
Evidence of the appropriate amount of fluid intake during the first few days after acute stroke was scarce. Concerns were raised in patients with acute malignant middle cerebral infarction, who tended to have malignant brain edema later. The purpose of the study was to evaluate the effect of fluid intake on the occurrence of malignant brain edema in patients with acute middle cerebral artery infarction. Patients with acute middle cerebral artery infarction who had National Institute of Health Stroke Scale (NIHSS) score of at least 15 were included. Baseline characteristics and amount of fluid intake during the first few days were compared in patients with and without malignant brain edema. One hundred ninety-three patients were studied. Mean NIHSS score was 20. Malignant brain edema occurred in 69 patients (36 %). Higher amount of fluid intake (>1650 ml or >28 ml/kg/day or >93 % of daily maintenance fluid) showed a significant association with malignant brain edema (OR = 13.86, 95 % CI 5.11–37.60, p value <0.001). Decompressive surgery was performed in 35 patients (18 %). With mean follow-up of 12 months, 49 patients (49/184, 27 %) had favorable outcomes (modified Rankin scale (mRS) 0–2) at final follow-up. Seventy-nine patients (79/184, 43 %) died. In the subgroup of patients with malignant brain edema, 39 patients (39/65, 60 %) died and only 11 % (7/65 patients) had favorable outcome. High amount of fluid intake in the first few days of acute middle cerebral infarction was related to the occurrence of malignant brain edema.
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References
Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. Malignant middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53:309–15.
Berrouschot J, Sterker M, Bettin S, Koster J, Schneider D. Mortality of space-occupying (malignant) middle cerebral artery infarction under conservative intensive care. Intensive Care Med. 1998;24:620–3.
Qureshi AI, Suares JI, Yahia AM, Mohammad Y, Uzun G, Suri MF, et al. Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicenter review. Crit Care Med. 2003;31:272–7.
Frank JI. Large hemispheric infarction, deterioration, and intracranial pressure. Neurology. 1995;45:1286–90.
Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2013;44:870–947.
Kenney WL, Chiu P. Influence of age on thirst and fluid intake. Med Sci Sports Exerc. 2001;33:1524–32.
Rodriguez GJ, Cordina SM, Vazquez G, Suri MF, Kirmani JF, Ezzeddine MA, et al. The hydration influence on the risk of stroke (THIRST) study. Neurocrit Care. 2009;10:187–94.
Bhalla A, Sankaralingam S, Dundas R, Swaminathan S, Wolfe CD, Rudd AG. Influence of raised plasma osmolarity on clinical outcome after acute stroke. Stroke. 2000;31:2043–8.
Asplund K. Haemodilution for acute ischemic stroke. Cochrane Database Syst Rev. 2002;4:CD000103.
Bistrain BB, Driscoll DF. Enteral and parenteral nutrition therapy. In: Fauci AS, Kasper DL, Longo DI, Braunwald E, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison’s principals of internal medicine. 17th ed. New York: McGraw-Hill; 2008. p. 455–61.
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This research was funded by Faculty of Medicine, Thammasat University.
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I declare that I have no conflict of interest.
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The research protocol was approved by the human ethics committee of the Faculty of Medicine, Thammasat University. Because this research was a retrospective study, informed consent is not required from all individual participants.
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Dharmasaroja, P.A. Fluid Intake Related to Brain Edema in Acute Middle Cerebral Artery Infarction. Transl. Stroke Res. 7, 49–53 (2016). https://doi.org/10.1007/s12975-015-0439-1
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DOI: https://doi.org/10.1007/s12975-015-0439-1