Hypervolemic Versus Normovolemic Therapy in Patients with Ruptured Cerebral Aneurysm

ABSTRACT

BACKGROUND: Postoperative triple H therapy is regarded as a mainstay for prophylaxis and treatment of delayed ischemic neurologic deficit (DIND) after subarachnoid hemorrhage (SAH). However, there are doubts about its effectiveness. This study was performed to assess hypervolemic dynamic fluid therapy in patients with ruptured cerebral aneurysms. METHODS: The authors retrospectively studied a total of 393 patients with ruptured cerebral aneurysms, consisting of early surgery with or without intraoperative ventriculostomy during a recent 5 year period (July 1998~June 2003). Hypervolemic dynamic fluid therapy was initiated postoperatively in patients with DIND. Since January 2001, however, patients were maintained in normovolemia and normotension, and when DIND had manifested, low molecular weight dextran was only added. The incidence of DIND and outcome according to Glasgow Outcome Scale at 6 months of the normovolemic group were compared with the hypervolemic group. All patients were followed for at least 14 days after the admission including clinical assessment, TCD recording, CT scanning, CVP measurements, and nimodipine infusion. RESULTS: Subjects in the two treatment groups were similar with regard to age, sex, Fisher grade, Hunt-Hess grade, aneurysm location, and aneurysm size. No differences were found between the two groups regarding the incidence of DIND (29/182: 15.9% vs 29/211: 13.7%). Surgical outcome in the normovolemic group (good, 171/211: 81.0%) was comparable to the hypervolemic group (good, 154/182: 84.6%). CONCLUSIONS: Although careful fluid management to avoid hypovolemia may reduce the risk of DIND after SAH, prophylactic hypervolemic dynamic fluid therapy is unlikely to confer an additional benefit.