gms | German Medical Science

Objective: Maintenance of physiologic fluid balance has been mentioned to be important in the literature in patients following aneurysmal subarachnoid hemorrhage (aSAH), since severe hypovolemia would be associated with an unfavourable clinical outcome. However, there is only a limited number of studies available investigating prospectively the volume status in patients following aSAH in relation to various outcome parameters.

Method: 32 patients following aSAH were prospectively investigated. Using a thermodilution method, the intrathoracic bloodvolume-index (ITBVI) and the extravasal lung water-index were determined daily until day 8 after bleeding. By definition, hypovolemia was present with an ITVBI below 800, pulmonary edema with an ELVI above 18. Both parameters were correlated with the amount of intracisternal blood following aSAB (Hijdra-Score), the degree of angiographic vasospasm and clinical outcome (modified Rankin Score).

Results: 11 patients showed hypovolemia, there was no patient with pathologic ELVI-values. There was no significant trend to observe within the individual volume status of the patients during the observational period. Mean ITBVI showed no significant correlation between clinical and radiological baseline parameters, such as initial Hunt&Hess degree and initial Hijdra-Score. There was no correlation between mean ITBVI and the degree of aVS and clinical outcome (mRankin).

Conclusions: The severity of the initial bleeding seems not to have a significant influence on the volume status of patients following aSAH. Likewise, the influence of pathologic ITBVI-values seems to be lower as previously assumed.