Haemodynamic augmentation in the treatment of vasospasm in aneurysmal subarachnoid hemorrhage

Abstract

Aim: Hypertension, hypervolemia and hemodilution therapy is a common approach to cerebral vasospasm after subarachnoid haemorrhage. This study is designed to see the difference of moderate or aggressive hypervolemia supported with induced hypertension in symptomatic vasospasm detected with transcranial Doppler ultrasonography (TCD) measurements.

Material and methods: Fifty eight patients who had aneurysm clipping and were admitted to the neurointensive care unit were treated with normovolemia and induced hypertension (n=35) or hypervolemia supported with induced hypertension (n=23) targeting a mean arterial pressure of 110-130 mm Hg and central venous pressure of 8-12 mm Hg. Daily TCD, fluid intake, fluid balance and haemodynamic values were recorded for 14 days.

Results: There were no differences detected in mean arterial pressure, central venous pressure, hematocrit values, fluid balance and middle cerebral artery flow velocities between the two groups through 14 days (p > 0.05). Hyponatremia, pulmonary edema and cerebral ischemia were observed as complications.

Conclusion: Hypervolemia adds no benefit compared to normovolemia in the treatment of vasospasm occurred as a result of subarachnoid hemorrhage. Induced hypertension establishes the haemodynamic augmentation to prevent and treat vasospasm.