Poor outcome is associated with less negative fluid balance in patients with aneurysmal subarachnoid hemorrhage treated with prophylactic vasopressor-induced hypertension

Sakr, Yasser; Dünisch, Pedro; Santos, Clesar; Matthes, Lena; Zeidan, Mohamed A.; Reinhart, Konrad; Kalff, Rolf; Ewald, Christian

doi:10.1186/s13613-016-0128-6

Cited by 20 publications

(19 citation statements)

References 39 publications

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“…An analysis of the vasopressin and septic shock trial [ 3 ] also showed that a more positive FB at 12 hours and cumulatively over 4 days is associated with increased risk of mortality. Similar results were also reported in other specific patient populations, such as those with acute renal failure [ 4 ], acute lung injury [ 5 ], aneurysmal subarachnoid hemorrhage (ASH) [ 6 ] and surgical patients [ 7 ].…”

Section: Introductionsupporting

confidence: 80%

“…Sakr et al [6] reported that a more negative FB (up to 7 days) is associated with better outcomes in patients with ASH (–0.7 L vs. –5.6 L, p < 0.001). However, this comparison between a slight and a more negative FB may have been influenced by the inclusion of patients with positive FB.…”

Section: Discussionmentioning

confidence: 99%

“…However, the current evidence focused on comparison between positive and negative FB, and whether achieving a more negative FB could further improve clinical outcomes in patients with negative FB remains unclear. Sakr et al [ 6 ] reported that a more negative FB (up to 7 days) is associated with better outcomes in patients with ASH (–0.7 L vs. –5.6 L, p < 0.001). However, this comparison between a slight and a more negative FB may have been influenced by the inclusion of patients with positive FB.…”

Section: Discussionmentioning

confidence: 99%

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Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study

Shen

Huang²,

Zhang

2017

Crit Care

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BackgroundCompared to positive fluid balance (FB), negative FB is associated with improved clinical outcomes in critically ill patients. However, as to whether achieving more negative FB can further improve outcomes has not been investigated. This study aimed to investigate whether more negative FB and restricted fluid intake were associated with improved outcomes in critically ill patients.MethodData were extracted from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. Patients achieving negative FB at 48 hours after intensive care unit (ICU) admission were screened. The primary outcome was hospital mortality. Logistic models were built to explore the association between FB, fluid intake and mortality, using FB and fluid intake (both four levels) as design variables and using the linear spline function method.ResultsThere were 2068 patients meeting the inclusion criteria. Compared to slight negative FB (level 1), there was a decreased tendency towards mortality with FB level 2 (OR 0.88, 95% CI 0.69–1.11) and level 3 (OR 0.79, 95% CI 0. 65–1.11); however, only extreme negative FB (level 4) was significant (OR 0.56, 95% CI 0. 33–0.95). Fluid intake and urine output were evenly distributed over the first 48 hours after ICU admission. Fluid intake was inversely associated with hospital mortality, with the OR decreased stepwise from level 2 (OR 0.73, 95% CI 0.56–0.96) to level 4 (OR 0.47, 95% CI 0.30–0.74), referred to level 1. Urine output also showed a similar pattern. Diuretic use was associated with higher mortality in both models.ConclusionIn critically ill patients with negative FB, both increased fluid intake and urine output were associated with decreased hospital mortality. However, compared to slight FB, achieving more negative FB was not associated with reduced mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1692-3) contains supplementary material, which is available to authorized users.

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Section: Introductionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study

Shen

Huang²,

Zhang

2017

Crit Care

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“…Although there is some evidence suggesting a beneficial physiologic effect on cerebral perfusion, 9 the various components were each the subject of dispute over the last several years. 10-12 The first effective medical intervention for the prevention of DCI was oral nimodipine, which was shown to reduce the rate of DCI and improve functional outcome. 13 , 14 …”

mentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage: Trends, Outcomes, and Predictions From a 15-Year Perspective of a Single Neurocritical Care Unit

et al. 2020

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BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is associated with disproportionally high mortality and long-term neurological sequelae. Management of patients with aSAH has changed markedly over the years, leading to improvements in outcome. OBJECTIVE To describe trends in aSAH care and outcome in a high-volume single center 15-yr cohort. METHODS All new admissions diagnosed with subarachnoid hemorrhage (SAH) to our tertiary neuro-intensive care unit between 2002 and 2016 were reviewed. Trend analysis was performed to assess temporal changes and a step-wise regression analysis was done to identify factors associated with outcomes. RESULTS Out of 3970 admissions of patients with SAH, 2475 patients proved to have a ruptured intracranial aneurysm. Over the years of the study, patient acuity increased by Hunt & Hess (H&H) grade and related complications. Endovascular therapies became more prevalent over the years, and were correlated with better outcome. Functional outcome overall improved, yet the main effect was noted in the low- and intermediate-grade patients. Several parameters were associated with poor functional outcome, including long-term mechanical ventilation (odds ratio 11.99, CI 95% [7.15-20.63]), acute kidney injury (3.55 [1.64-8.24]), pneumonia (2.89 [1.89-4.42]), hydrocephalus (1.80 [1.24-2.63]) diabetes mellitus (1.71 [1.04-2.84]), seizures (1.69 [1.07-2.70], H&H (1.67 [1.45-1.94]), and age (1.06 [1.05-1.07]), while endovascular approach to treat the aneurysm, compared with clip-ligation, had a positive effect (0.35 [0.25-0.48]). CONCLUSION This large, single referral center, retrospective analysis reveals important trends in the treatment of aSAH. It also demonstrates that despite improvement in functional outcome over the years, systemic complications remain a significant risk factor for poor prognosis. The historic H&H determination of outcome is less valid with today's improved care.

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“…Remarkably, comparable findings were reported in other studies, primarily focusing on non-ischemic cerebral injuries as for instance subarachnoid hemorrhage (SAH). In detail, three studies have reported the association between a greater cumulative fluid balance within the first days after the bleeding event and an elevated risk of poor outcome (23–25). Also in a time frame beyond the first days after SAH, which represents the subacute and thus critical period for the generation of vasospasm, the induction of a positive fluid balance was found to be associated with a poor functional outcome (20).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Poor outcome is associated with less negative fluid balance in patients with aneurysmal subarachnoid hemorrhage treated with prophylactic vasopressor-induced hypertension

Cited by 20 publications

References 39 publications

Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study

Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study

Aneurysmal Subarachnoid Hemorrhage: Trends, Outcomes, and Predictions From a 15-Year Perspective of a Single Neurocritical Care Unit

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

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