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Early intensive versus minimally invasive approach to postoperative hemodynamic management after subarachnoid hemorrhage.

Abstract：

BACKGROUND AND PURPOSE:The results of previous studies suggest that early goal-directed fluid therapy (EGDT) reduces delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage, but the effects of EGDT on clinical outcomes are still unclear. This study aimed to determine whether EGDT improves outcomes compared with standard less-invasive hemodynamic therapy. METHODS:This study included 160 patients treated within 24 hours after subarachnoid hemorrhage, randomized to receive either (1) EGDT guided by preload volume and cardiac output monitored by transpulmonary thermodilution (treatment group) or (2) standard therapy guided by fluid balance or central venous pressure, assisted by uncalibrated less-invasive cardiac output monitoring during hyperdynamic therapy in patients with clinical or radiological indications of DCI (control group). DCI determined by clinical or radiological findings and functional outcome determined by the modified Rankin Scale score at 3 months were compared between groups. RESULTS:For all clinical grades combined, there were no significant differences in the rates of DCI (33% versus 42%; P=0.33) or modified Rankin Scale score of 0 to 3 at 3 months (67% versus 57%; P=0.22) between the 2 groups. For patients with poor clinical grade, those who received EGDT had a significantly lower rate of DCI (5% versus 14%; P=0.036), modified Rankin Scale score of 0 to 3 at 3 months (52% versus 36%; P=0.026), and shorter length of intensive care unit stay (14 versus 17 days; P=0.043) than those who received standard therapy. CONCLUSIONS:EGDT is beneficial for reducing DCI and improving postoperative functional outcome in patients with poor clinical grade. CLINICAL TRIAL REGISTRATION URL:http://www.clinicaltrials.gov. Unique identifier: UMIN000007509.

journal_name

Stroke

journal_title

Stroke

authors

Mutoh T,Kazumata K,Terasaka S,Taki Y,Suzuki A,Ishikawa T

doi

10.1161/STROKEAHA.114.004739

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

1280-4

issue

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.114.004739

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Early intensive versus minimally invasive approach to postoperative hemodynamic management after subarachnoid hemorrhage.