Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010;14(2):R43.
doi: 10.1186/cc8930. Epub 2010 Mar 23.

Pulmonary edema and blood volume after aneurysmal subarachnoid hemorrhage: a prospective observational study

Reinier G Hoff  1 , Gabriel J E Rinkel, Bon H Verweij, Ale Algra, Cor J Kalkman
Affiliations

Pulmonary edema and blood volume after aneurysmal subarachnoid hemorrhage: a prospective observational study

Reinier G Hoff et al. Crit Care. 2010.

Abstract

Introduction: Pulmonary edema (PED) is a severe complication after aneurysmal subarachnoid hemorrhage (SAH). PED is often treated with diuretics and a reduction in fluid intake, but this may cause intravascular volume depletion, which is associated with secondary ischemia after SAH. We prospectively studied intravascular volume in SAH patients with and without PED.

Methods: Circulating blood volume (CBV) was determined daily during the first 10 days after SAH by means of pulse dye densitometry. CBV of 60-80 ml/kg was considered normal. PED was diagnosed from clinical signs and characteristic bilateral pulmonary infiltrates on the chest radiograph. We compared CBV, cardiac index, and fluid balance between patients with and without PED with weighted linear regression, taking into account only measurements from the first day after SAH through to the day on which PED was diagnosed. Differences were adjusted for age, bodyweight, and clinical condition.

Results: In total, 102 patients were included, 17 of whom developed PED after a mean of 4 days after SAH. Patients developing PED had lower mean CBV (56.6 ml/kg) than did those without PED (66.8 ml/kg). The mean difference in CBV was -11.3 ml/kg (95% CI, -16.5 to -6.1); adjusted mean difference, -8.0 ml/kg (95% CI, -14.0 to -2.0). After adjusting, no differences were found in cardiac index or fluid balance between patients with and without PED.

Conclusions: SAH patients developing pulmonary edema have a lower blood volume than do those without PED and are hypovolemic. Measures taken to counteract pulmonary edema must be balanced against the risk of worsening hypovolemia.

Trial registration: NTR1255.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of patient inclusion and treatment allocation.
See this image and copyright information in PMC

Comment in

References

    1. Macmillan CSA, Grant IS, Andrews PJD. Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management? Intensive Care Med. 2002;28:1012–1023. doi: 10.1007/s00134-002-1382-7. - DOI - PubMed
    1. Muroi C, Keller M, Pangalu A, Fortunati M, Yonekawa Y, Keller E. Neurogenic pulmonary edema in patients with subarachnoid hemorrhage. J Neurosurg Anesthesiol. 2008;20:188–192. doi: 10.1097/ANA.0b013e3181778156. - DOI - PubMed
    1. Kramer AH, Bleck TP, Dumont AS, Kassell NF, Olson C, Nathan B. Implications of early versus late bilateral pulmonary infiltrates in patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2009;10:20–27. doi: 10.1007/s12028-008-9137-0. - DOI - PubMed
    1. Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiol Scand. 2007;51:447–455. doi: 10.1111/j.1399-6576.2007.01276.x. - DOI - PubMed
    1. Deehan SC, Grant IS. Haemodynamic changes in neurogenic pulmonary oedema: effect of dobutamine. Intensive Care Med. 1996;22:672–676. doi: 10.1007/BF01709745. - DOI - PubMed

Publication types

LinkOut - more resources