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Fluid Responsiveness and Brain Tissue Oxygen Augmentation After Subarachnoid Hemorrhage

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Abstract

Background

The objective of this study was to investigate the relationship between cardiac index (CI) response to a fluid challenge and changes in brain tissue oxygen pressure (PbtO2) in patients with subarachnoid hemorrhage (SAH).

Methods

Prospective observational study was conducted in a neurological intensive care unit of a university hospital. Fifty-seven fluid challenges were administered to ten consecutive comatose SAH patients that underwent multimodality monitoring of CI, intracranial pressure (ICP), and PbtO2, according to a standardized fluid management protocol.

Results

The relationship between CI and PbtO2 was analyzed with logistic regression utilizing generalized estimating equations. Of the 57 fluid boluses analyzed, 27 (47 %) resulted in a ≥ 10 % increase in CI. Median absolute (+5.8 vs. +1.3 mmHg) and percent (20.7 vs. 3.5 %) changes in PbtO2 were greater in CI responders than in non-responders within 30 min after the end of the fluid bolus infusion. In a multivariable model, a CI response was independently associated with PbtO2 response (adjusted odds ratio 21.5, 95 % CI 1.4–324, P = 0.03) after adjusting for mean arterial pressure change and end-tidal CO2. Stroke volume variation showed a good ability to predict CI and PbtO2 response with areas under the ROC curve of 0.86 and 0.81 with the best cut-off values of 9 % for both responses.

Conclusion

Bolus fluid resuscitation resulting in augmentation of CI can improve cerebral oxygenation after SAH.

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Authors and Affiliations

  1. Division of Critical Care Neurology, Department of Neurology, Columbia University, Milstein Hospital 8 Center, 177 Fort Washington Ave, New York, NY, 10032, USA

    Pedro Kurtz, Raimund Helbok, Sang-bae Ko, Jan Claassen, J. Michael Schmidt, Luis Fernandez, Neeraj Badjatia, Stephan A. Mayer & Kiwon Lee

  2. Department of Neurological Surgery, Columbia University, New York, NY, USA

    R. Morgan Stuart & E. Sander Connolly

Authors
  1. Pedro Kurtz
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  2. Raimund Helbok
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  3. Sang-bae Ko
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  4. Jan Claassen
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  5. J. Michael Schmidt
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  6. Luis Fernandez
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  7. R. Morgan Stuart
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  9. Neeraj Badjatia
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  10. Stephan A. Mayer
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  11. Kiwon Lee
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Correspondence to Kiwon Lee.

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Kurtz, P., Helbok, R., Ko, Sb. et al. Fluid Responsiveness and Brain Tissue Oxygen Augmentation After Subarachnoid Hemorrhage. Neurocrit Care 20, 247–254 (2014). https://doi.org/10.1007/s12028-013-9910-6

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  • DOI: https://doi.org/10.1007/s12028-013-9910-6

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