The association between fluid balance and outcomes after subarachnoid hemorrhage

Ross P. Martini, Steven Deem, Marcia Brown, Michael J. Souter, Norbert Yanez, Stephen Daniel, Miriam Treggiari

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background We sought to determine the association between early fluid balance and neurological/vital outcome of patients with subarachnoid hemorrhage. Methods Hospital admission, imaging, ICU and outcome data were retrospectively collected from the medical records of adult patients with aneurysmal SAH admitted to a level-1 trauma and stroke referral center during a 5-year period. Two groups were identified based on cumulative fluid balance by ICU day 3: (i) patients with a positive fluid balance (n = 221) and (ii) patients with even or negative fluid balance (n = 135). Multivariable logistic regression was used to adjust for age, Hunt-Hess and Fisher scores, mechanical ventilation and troponin elevation (>0.40 ng/ ml) at ICU admission. The primary outcome was a composite of hospital mortality or new stroke. Results Patients with positive fluid balance had worse admission GCS and Hunt-Hess score, and by ICU day 3 had cumulatively received more IV fluids, but had less urine output when compared with the negative fluid balance group. There was no difference in the odds of hospital death or new stroke (adjusted OR: 1.47, 95%CI: 0.85, 2.54) between patients with positive and negative fluid balance. However, positive fluid balance was associated with increased odds of TCD vasospasm (adjusted OR 2.25, 95%CI: 1.37, 3.71) and prolonged hospital length of stay. Conclusions Although handling of IV fluid administration was not an independent predictor of mortality or new stroke, patients with early positive fluid balance had worse clinical presentation and had greater resource use during the hospital course.

Original languageEnglish (US)
Pages (from-to)191-198
Number of pages8
JournalNeurocritical Care
Volume17
Issue number2
DOIs
StatePublished - Oct 2012
Externally publishedYes

Fingerprint

Water-Electrolyte Balance
Subarachnoid Hemorrhage
Stroke
Length of Stay
Troponin
Hospital Mortality
Artificial Respiration
Medical Records
Referral and Consultation
Logistic Models
Urine
Mortality
Wounds and Injuries

Keywords

  • Cerebral aneurysm
  • Cerebral vasospasm
  • Delayed ischemic neurologic deficit
  • Hemodilution
  • Human
  • Hypertension
  • Hypervolemia
  • Subarachnoid hemorrhage
  • Triple-H therapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

The association between fluid balance and outcomes after subarachnoid hemorrhage. / Martini, Ross P.; Deem, Steven; Brown, Marcia; Souter, Michael J.; Yanez, Norbert; Daniel, Stephen; Treggiari, Miriam.

In: Neurocritical Care, Vol. 17, No. 2, 10.2012, p. 191-198.

Research output: Contribution to journalArticle

Martini, Ross P. ; Deem, Steven ; Brown, Marcia ; Souter, Michael J. ; Yanez, Norbert ; Daniel, Stephen ; Treggiari, Miriam. / The association between fluid balance and outcomes after subarachnoid hemorrhage. In: Neurocritical Care. 2012 ; Vol. 17, No. 2. pp. 191-198.
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