Volume of Plasma Expansion and Functional Outcomes in Stroke

Miller, Joseph; Lewandowski, Christopher; Wira, Charles; Taylor, Andrew; Burmeister, Charlotte; Welch, Robert D.

doi:10.1007/s12028-016-0316-0

Cited by 3 publications

(2 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a secondary analysis of the data from the Albumin in Acute Stroke Part 2 trial (ALIAS 2), Miller et al investigated the relationship between the magnitude of overall intravenous volume infusion over the first 48 h and the clinical outcome at day 90. Although this study did not focus on LHS and the period of controlled volume application appears rather short, they found an association between a greater volume of plasma expansion and a worse neurological recovery (26). On the other hand, dehydration represents a well-established risk factor for poor outcome after ischaemic stroke.…”

Section: Discussionmentioning

confidence: 76%

Fluid Balance Variations During the Early Phase of Large Hemispheric Stroke Are Associated With Patients' Functional Outcome

et al. 2019

View full text Add to dashboard Cite

Background: From the variety of factors underlying the ischemia-associated edema formation in large hemispheric stroke (LHS), an increased brain water content during the early phase seems to have a pivotal role for long-lasting tissue damage. However, the importance of the fluid management during the acute phase of LHS has so far not been adequately studied. Therefore, this study explored the association between the fluid balance and functional outcome in patients suffering from LHS. Methods: We analyzed hospital-based medical records of 39 consecutive patients with LHS and decompressive hemicraniectomy. Over the first 10 days after admission, the volumes of all administered fluids were assessed daily and corrected for daily urinary output and insensible loss. Functional outcome at 3 months was assessed with the modified Rankin Scale (mRS) and dichotomized into an acceptable (mRS ≤ 4) vs. a poor outcome (mRS ≥ 5). Results: Compared to patients with a poor functional outcome ( n = 19), those with an acceptable outcome ( n = 20) were characterized by a significantly lower cumulative net fluid balance at day 5 (1.6 ± 2.5 vs. 3.4 ± 4.4 l), day 7 (2.0 ± 2.9 vs. 4.6 ± 5.2 l), and day 10 (0 ± 2.5 vs. 5.6 ± 6.2 l). In addition to age, only the cumulative net fluid balance at day 10 served as an independent factor for poor functional outcome in multiple regression analyses. Conclusion: These data provide evidence for a critical role of the early phase net fluid balance with respect to the functional outcome after LHS. This observation leads to the hypothesis that patients with LHS might benefit from a more restrictive volume therapy. However, prospective studies are warranted to establish a causal relationship and recommendations for treatment strategies.

show abstract

Section: Discussionmentioning

confidence: 76%

Fluid Balance Variations During the Early Phase of Large Hemispheric Stroke Are Associated With Patients' Functional Outcome

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Pilot data from [32] strongly support the link between CO and cerebral perfusion, and are the basis for this group’s recently reported clinical trial design [33], the results of which we eagerly await. Conversely, the risks of volume therapy without CO guidance are suggested by a secondary analysis of the Albumin in Acute Stroke Part 2 (ALIAS 2) trial [34]. This analysis found that larger strokes, and higher NIHSS scores, were associated with larger volumes of fluid.…”

Section: Targeting Fluid Therapymentioning

confidence: 99%

Fluid management concepts for severe neurological illness

Heifets

Tanaka²,

Burbridge³

2018

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

As the possibility grows closer that we can monitor the physiological parameters with direct relevance for neurological outcomes and the various complications associated with neurocritical illness, we may finally move away from static therapy recommendations, and toward individualized, precise therapy. Although we believe therapy should ultimately be individualized rather than standardized, it is clear that the monitoring tools and analytical methods used ought to be standardized to facilitate appropriately powered, prospective clinical outcome trials.

show abstract

Akut İskemik Strok Tedavisinde Hemodilüsyonun Etkinliğinin Vasomotor Reaktivite ve Serebral Oksimetre ile Değerlendirilmesi

Yavaş

Adapınar

2019

Osmangazi̇ Journal of Medicine

View full text Add to dashboard Cite

Özet: Hemodilüsyon serebral kan akımını artırarak nöroprotektif etki göstermekte. Bu etkinin kısa ve uzun vadedeki sonuçlarını vasomotor reaktivite testi ve serebral oksimetre ile test etmeyi amaçladık. Gereç ve yöntemler: İskemik stroklu hastalar ardışık sistemle hemodilüsyon ve kontrol grubuna kabul edildi. Hemodilüsyon ilk 24 sa içinde uygulandı. Hematokrit düzeyine göre hipervolemik, izovolemik ya da hipovolemik hemodilüsyon uygulandı. Hemodilüsyon öncesi, sonrası 5.gün ve 90.gün transkranial doppler ile vasomotor reaktivite (VMR) testi, INVOS 3100 Cerebral Oximeter ile oksijen dağımı ve klinik değerlendirmeleri yapıldı. Klinik değerlendirmede Glaskow koma skalası, Bartel, Rankın, SSS, MCANS, HSS kullanıldı. Sonuçlar descriptive statistics, varyans analizi ve t-test ile değerlendirildi. Bulgular: Hemodilüsyon grubunda 21, kontrol grubunda 20 hasta vardı. Yaş ortalaması 61,2 idi. VMR testinde ve oksimetride oksijen değerlerinde iki grup birbiri ile ve günlere göre karşılaştırmada anlamlı bir farklılık bulunmamıştır. Klinik değerlendirmede 90. Günde hemodilüsyon grubunda SSS ve MCANS değerleri daha iyi bulunmuştur. Hemodilüsyon WMR testinde ve oksijen dağılımında anlamlı bir etki göstermemiştir. Uzun dönemde klinik iyileşmede etkili bulunmuştur.

show abstract

Volume of Plasma Expansion and Functional Outcomes in Stroke

Abstract: The present study demonstrates an association between greater volume of plasma expansion and worse neurological recovery.

Cited by 3 publications

References 11 publications

Fluid Balance Variations During the Early Phase of Large Hemispheric Stroke Are Associated With Patients' Functional Outcome

Fluid Balance Variations During the Early Phase of Large Hemispheric Stroke Are Associated With Patients' Functional Outcome

Fluid management concepts for severe neurological illness

Akut İskemik Strok Tedavisinde Hemodilüsyonun Etkinliğinin Vasomotor Reaktivite ve Serebral Oksimetre ile Değerlendirilmesi

Contact Info

Product

Resources

About