Goal-Directed Fluid Management by Bedside Transpulmonary Hemodynamic Monitoring After Subarachnoid Hemorrhage
Optimal monitoring of cardiac output and intravascular volume is of paramount importance for good fluid management of patients with subarachnoid hemorrhage (SAH). The aim of this study was to demonstrate the feasibility of advanced hemodynamic monitoring with transpulmonary thermodilution and to pro...
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| Veröffentlicht in: | Stroke (1970) 2007-12, Vol.38 (12), p.3218-3224 |
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| creator | MUTOH, Tatsushi KAZUMATA, Ken AJIKI, Minoru USHIKOSHI, Satoshi TERASAKA, Shunsuke |
| description | Optimal monitoring of cardiac output and intravascular volume is of paramount importance for good fluid management of patients with subarachnoid hemorrhage (SAH). The aim of this study was to demonstrate the feasibility of advanced hemodynamic monitoring with transpulmonary thermodilution and to provide descriptive data early after SAH.
Forty-six patients with SAH treated within 24 hours of the ictus were investigated. Specific targets for cardiac index (>or=3.0 L x min(-1) x m(-2)), global end-diastolic volume index (700 to 900 mL/m(2)), and extravascular lung water index ( |
| doi_str_mv | 10.1161/strokeaha.107.484634 |
| format | Article |
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Forty-six patients with SAH treated within 24 hours of the ictus were investigated. Specific targets for cardiac index (>or=3.0 L x min(-1) x m(-2)), global end-diastolic volume index (700 to 900 mL/m(2)), and extravascular lung water index (<or=14 mL/kg) were established by the single-indicator transpulmonary thermodilution technique, and a fluid management protocol emphasizing supplemental colloid administration was used to attain these targets. Plasma hormones related to stress and fluid regulation were also measured.
A higher cardiac index (mean value of 5.3 L x min(-1) x m(-2)) and a lower global end-diastolic volume index (555 mL/m(2)) were observed on initial measurement, for which elevations of plasma adrenaline, noradrenaline, and cortisol were also detected. Cardiac index was progressively decreased (3.5 L x min(-1) x m(-2)) and global end-diastolic volume index was normalized by fluid administration aimed at normovolemia. The extent of the initial hemodynamic and hormonal profile was greater in patients with a poor clinical status (P<0.05). The extravascular lung water index was mildly elevated but within the target range throughout the study period. No patients developed pulmonary edema or congestive heart failure.
The impact of sympathetic hyperactivity after SAH predisposes patients to a hyperdynamic and hypovolemic state, especially in those whose clinical status is poor. Bedside monitoring with the transpulmonary thermodilution system may be a powerful tool for the systemic management of such patients.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/strokeaha.107.484634</identifier><identifier>PMID: 17991892</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood Volume ; Blood Volume Determination ; Cardiac Output ; Emergency and intensive care: comas and nervous system diseases ; Extravascular Lung Water ; Female ; Hemodynamics ; Humans ; Intensive care medicine ; Lung - pathology ; Male ; Medical sciences ; Middle Aged ; Monitoring, Physiologic - methods ; Myocardium - pathology ; Neurology ; Neurosurgery ; Skull, brain, vascular surgery ; Subarachnoid Hemorrhage - diagnosis ; Subarachnoid Hemorrhage - metabolism ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2007-12, Vol.38 (12), p.3218-3224</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-fc17223f5fdda56f53cfc4be280561c05e54b7e3d654cc33c338cdd622a29ac63</citedby><cites>FETCH-LOGICAL-c447t-fc17223f5fdda56f53cfc4be280561c05e54b7e3d654cc33c338cdd622a29ac63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,3674,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19876230$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17991892$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MUTOH, Tatsushi</creatorcontrib><creatorcontrib>KAZUMATA, Ken</creatorcontrib><creatorcontrib>AJIKI, Minoru</creatorcontrib><creatorcontrib>USHIKOSHI, Satoshi</creatorcontrib><creatorcontrib>TERASAKA, Shunsuke</creatorcontrib><title>Goal-Directed Fluid Management by Bedside Transpulmonary Hemodynamic Monitoring After Subarachnoid Hemorrhage</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Optimal monitoring of cardiac output and intravascular volume is of paramount importance for good fluid management of patients with subarachnoid hemorrhage (SAH). The aim of this study was to demonstrate the feasibility of advanced hemodynamic monitoring with transpulmonary thermodilution and to provide descriptive data early after SAH.
Forty-six patients with SAH treated within 24 hours of the ictus were investigated. Specific targets for cardiac index (>or=3.0 L x min(-1) x m(-2)), global end-diastolic volume index (700 to 900 mL/m(2)), and extravascular lung water index (<or=14 mL/kg) were established by the single-indicator transpulmonary thermodilution technique, and a fluid management protocol emphasizing supplemental colloid administration was used to attain these targets. Plasma hormones related to stress and fluid regulation were also measured.
A higher cardiac index (mean value of 5.3 L x min(-1) x m(-2)) and a lower global end-diastolic volume index (555 mL/m(2)) were observed on initial measurement, for which elevations of plasma adrenaline, noradrenaline, and cortisol were also detected. Cardiac index was progressively decreased (3.5 L x min(-1) x m(-2)) and global end-diastolic volume index was normalized by fluid administration aimed at normovolemia. The extent of the initial hemodynamic and hormonal profile was greater in patients with a poor clinical status (P<0.05). The extravascular lung water index was mildly elevated but within the target range throughout the study period. No patients developed pulmonary edema or congestive heart failure.
The impact of sympathetic hyperactivity after SAH predisposes patients to a hyperdynamic and hypovolemic state, especially in those whose clinical status is poor. Bedside monitoring with the transpulmonary thermodilution system may be a powerful tool for the systemic management of such patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood Volume</subject><subject>Blood Volume Determination</subject><subject>Cardiac Output</subject><subject>Emergency and intensive care: comas and nervous system diseases</subject><subject>Extravascular Lung Water</subject><subject>Female</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Lung - pathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic - methods</subject><subject>Myocardium - pathology</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Skull, brain, vascular surgery</subject><subject>Subarachnoid Hemorrhage - diagnosis</subject><subject>Subarachnoid Hemorrhage - metabolism</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1rGzEQhkVIady0_yAUXdLbuvre3aPjJnFpQqBxz4tWGsVqdiVX2j3431fBhsDAwPC8L8yD0BUlS0oV_Z6nFF9B7_SSknopGqG4OEMLKpmohGLNOVoQwtuKiba9QJ9y_ksIYbyRH9EFrduWNi1boPE-6qH64ROYCSy-G2Zv8aMO-gVGCBPuD_gGbPYW8DbpkPfzMMag0wFvYIz2EPToDX6MwU8x-fCCV26ChJ_nXidtdiGWujcypV2p_Iw-OD1k-HLal-jP3e12vakenu5_rlcPlRGinipnaM0Yd9JZq6VykhtnRA-sIVJRQyRI0dfArZLCGM7LNMZaxZhmrTaKX6Jvx959iv9myFM3-mxgGHSAOOdONVJQwnkBxRE0KeacwHX75MfyXkdJ96a5e97-fvp1u9qsyqXujppL7Oupf-5HsO-hk9cCXJ8AnY0eXFFnfH7n2qZWjBP-HwuyiY0</recordid><startdate>20071201</startdate><enddate>20071201</enddate><creator>MUTOH, Tatsushi</creator><creator>KAZUMATA, Ken</creator><creator>AJIKI, Minoru</creator><creator>USHIKOSHI, Satoshi</creator><creator>TERASAKA, Shunsuke</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20071201</creationdate><title>Goal-Directed Fluid Management by Bedside Transpulmonary Hemodynamic Monitoring After Subarachnoid Hemorrhage</title><author>MUTOH, Tatsushi ; KAZUMATA, Ken ; AJIKI, Minoru ; USHIKOSHI, Satoshi ; TERASAKA, Shunsuke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-fc17223f5fdda56f53cfc4be280561c05e54b7e3d654cc33c338cdd622a29ac63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood Volume</topic><topic>Blood Volume Determination</topic><topic>Cardiac Output</topic><topic>Emergency and intensive care: comas and nervous system diseases</topic><topic>Extravascular Lung Water</topic><topic>Female</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Lung - pathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic - methods</topic><topic>Myocardium - pathology</topic><topic>Neurology</topic><topic>Neurosurgery</topic><topic>Skull, brain, vascular surgery</topic><topic>Subarachnoid Hemorrhage - diagnosis</topic><topic>Subarachnoid Hemorrhage - metabolism</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MUTOH, Tatsushi</creatorcontrib><creatorcontrib>KAZUMATA, Ken</creatorcontrib><creatorcontrib>AJIKI, Minoru</creatorcontrib><creatorcontrib>USHIKOSHI, Satoshi</creatorcontrib><creatorcontrib>TERASAKA, Shunsuke</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MUTOH, Tatsushi</au><au>KAZUMATA, Ken</au><au>AJIKI, Minoru</au><au>USHIKOSHI, Satoshi</au><au>TERASAKA, Shunsuke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Goal-Directed Fluid Management by Bedside Transpulmonary Hemodynamic Monitoring After Subarachnoid Hemorrhage</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2007-12-01</date><risdate>2007</risdate><volume>38</volume><issue>12</issue><spage>3218</spage><epage>3224</epage><pages>3218-3224</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Optimal monitoring of cardiac output and intravascular volume is of paramount importance for good fluid management of patients with subarachnoid hemorrhage (SAH). The aim of this study was to demonstrate the feasibility of advanced hemodynamic monitoring with transpulmonary thermodilution and to provide descriptive data early after SAH.
Forty-six patients with SAH treated within 24 hours of the ictus were investigated. Specific targets for cardiac index (>or=3.0 L x min(-1) x m(-2)), global end-diastolic volume index (700 to 900 mL/m(2)), and extravascular lung water index (<or=14 mL/kg) were established by the single-indicator transpulmonary thermodilution technique, and a fluid management protocol emphasizing supplemental colloid administration was used to attain these targets. Plasma hormones related to stress and fluid regulation were also measured.
A higher cardiac index (mean value of 5.3 L x min(-1) x m(-2)) and a lower global end-diastolic volume index (555 mL/m(2)) were observed on initial measurement, for which elevations of plasma adrenaline, noradrenaline, and cortisol were also detected. Cardiac index was progressively decreased (3.5 L x min(-1) x m(-2)) and global end-diastolic volume index was normalized by fluid administration aimed at normovolemia. The extent of the initial hemodynamic and hormonal profile was greater in patients with a poor clinical status (P<0.05). The extravascular lung water index was mildly elevated but within the target range throughout the study period. No patients developed pulmonary edema or congestive heart failure.
The impact of sympathetic hyperactivity after SAH predisposes patients to a hyperdynamic and hypovolemic state, especially in those whose clinical status is poor. Bedside monitoring with the transpulmonary thermodilution system may be a powerful tool for the systemic management of such patients.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>17991892</pmid><doi>10.1161/strokeaha.107.484634</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Volume Blood Volume Determination Cardiac Output Emergency and intensive care: comas and nervous system diseases Extravascular Lung Water Female Hemodynamics Humans Intensive care medicine Lung - pathology Male Medical sciences Middle Aged Monitoring, Physiologic - methods Myocardium - pathology Neurology Neurosurgery Skull, brain, vascular surgery Subarachnoid Hemorrhage - diagnosis Subarachnoid Hemorrhage - metabolism Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Vascular diseases and vascular malformations of the nervous system |
| title | Goal-Directed Fluid Management by Bedside Transpulmonary Hemodynamic Monitoring After Subarachnoid Hemorrhage |
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