The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage

Szmuda, Tomasz; Waszak, Przemysław; Rydz, Cezary; Springer, Janusz; Budynko, Lukasz; Szydło, Anna; Słoniewski, Paweł; Dzierżanowski, Jarosław

doi:10.1016/j.pjnns.2014.09.001

Cited by 5 publications

(16 citation statements)

References 30 publications

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“…Of the included studies, 18 reported the prevalence of patients with fluid balance monitored using a fluid balance chart. Of those, seven found a proportion of complete fluid balance charts of no more than 25%,33 43 45 46 48 50 54 three studies found a proportion between 26% and 50%,36 40 47 and in five studies, the proportions were reported to be between 51% and 75% 32 37 39 41 42. Only three studies reported that more than 75% of patients had a complete fluid balance chart34 35 38 (figure 2).…”

Section: Resultsmentioning

confidence: 98%

“…The studies comprised 12 studies categorised as quasi-experimental,33 40–43 45–47 49–51 54 3 cohort studies32 37 44 and 8 prevalence studies (cross-sectional studies) 34–36 38 39 48 52 53. All were appraised using the JBI tools for assessing quasi-experimental and prevalence studies.…”

Section: Resultsmentioning

confidence: 99%

“…Only 3 studies were of high quality,37 48 53 12 of moderate quality32 34–36 38 39 43–46 50 52 and 8 of low quality 33 40–42 47 49 51 54. Details of the quality appraisal can be found in table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies investigated the prevalence of calculation errors in fluid balance charts 34 36 38 39 44 49 54. Four were performed in ICUs 34 38 39 44.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies investigated the prevalence of calculation errors in fluid balance charts 34 36 38 39 44 49 54. Four were performed in ICUs 34 38 39 44. One study examining miscalculations in an ICU found a median calculation error in the daily fluid balance charts of 58 mL (range 1–1464 mL) and a cumulative median calculation error of 131 (range 1–2405 mL) 44.…”

Section: Resultsmentioning

confidence: 99%

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Quality of fluid balance charting and interventions to improve it: a systematic review

Leinum,

Krogsgaard,

Tantholdt-Hansen

et al. 2023

BMJ Open Qual

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IntroductionFluid balance monitoring is pivotal to patients’ health. Thus, fluid balance charting is an essential part of clinical nursing documentation. This systematic review aimed to investigate and describe the quality of fluid balance monitoring in medical, surgical and intensive care units, with an emphasis on the completeness of charting data, calculation errors and accuracy, and to evaluate methods used to improve fluid balance charting.Materials and methodsQuantitative studies involving adult patients and reporting data on fluid balance monitoring were included in the review. We searched MEDLINE, Embase, CINAHL and the Cochrane Library. The risk of bias in the included studies was assessed using tools developed by the Joanna Briggs Institute.ResultsWe included a total of 23 studies, which involved 6649 participants. The studies were quasi-experimental, cohort or prevalence studies, and every third study was of low quality. Definitions of ‘completeness’ varied, as well as patient categories and time of evaluation. Eighteen studies reported the prevalence of patients with complete fluid balance charts; of those, 10 reported that not more than 50% of fluid balance charts were complete. Studies addressing calculation errors found them in 25%–35% of charts, including omissions of, for example, intravenous medications. The reported interventions consisted of various components such as policies, education, equipment, visual aids, surveillance and dissemination of results. Among studies evaluating interventions, only 38% (5 of 13) achieved compliance with at least 75% of complete fluid balance charts. Due to the heterogeneity of the studies, a meta-analysis was not possible.ConclusionThe quality of fluid balance charting is inadequate in most studies, and calculation errors influence quality. Interventions included several components, and the impact on the completion of fluid balance charts varied.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Seven studies investigated the prevalence of calculation errors in fluid balance charts 34 36 38 39 44 49 54. Four were performed in ICUs 34 38 39 44.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Quality of fluid balance charting and interventions to improve it: a systematic review

Leinum,

Krogsgaard,

Tantholdt-Hansen

et al. 2023

BMJ Open Qual

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Comparison of the timing of intervention and treatment modality of poor-grade aneurysmal subarachnoid hemorrhage

Tykocki

Czyż

Machaj

et al. 2017

British Journal of Neurosurgery

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Fluid Intake But Not Fluid Balance Is Associated With Poor Outcome in Nontraumatic Subarachnoid Hemorrhage Patients

Rass

Gaasch

Kofler

et al. 2019

Critical Care Medicine

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Objectives: Optimal fluid management is important in patients with acute brain injury, including subarachnoid hemorrhage. We aimed to examine the relationship between daily fluid intake and fluid balance with hospital complications and functional outcome. Design: Retrospective observational cohort study. Setting: Neurocritical care unit at a tertiary academic medical center. Patients: Two-hundred thirty-seven consecutive nontraumatic subarachnoid hemorrhage patients admitted to the neurologic ICU between 2010 and 2016. Interventions: Total daily amount of fluids and fluid balance were calculated over 15 days. Using multivariate generalized estimating equation models the association of daily fluid intake and fluid balance with disease severity, hospital complications and poor functional outcome (3-mo modified Rankin Score ≥ 3) was investigated. Additionally, we described the composition of fluids given. Measurements and Main Results: Patients presented with a median admission Hunt and Hess grade of 3 (interquartile range, 1–5) and were 57 years old (interquartile range, 47–67 yr old). A higher daily fluid intake was associated with higher admission Hunt and Hess grade (odds ratio, 1.61; 95% CI, 1.47–1.76; p < 0.001), increased pulmonary fluid accumulation (adjusted odds ratio, 1.11; 95% CI, 1.01–1.21; p = 0.033), prolonged mechanical ventilation (Wald statistic = 20.08; degrees of freedom = 1; p < 0.001), higher daily Subarachnoid hemorrhage Early Brain Edema Score (adjusted odds ratio, 1.11; 95% CI, 1.01–1.22; p = 0.034), occurrence of anemia (adjusted odds ratio, 1.36; 95% CI, 1.20–1.54; p < 0.001), delayed cerebral ischemia (adjusted odds ratio, 1.31; 95% CI, 1.14–1.51; p < 0.001), and poor functional outcome (adjusted odds ratio, 1.25; 95% CI, 1.10–1.41; p < 0.001). Daily fluid balance was associated with higher admission Hunt and Hess grade (odds ratio, 1.09; 95% CI, 1.05–1.13; p < 0.001) and anemia (adjusted odds ratio, 1.17; 95% CI, 1.03–1.33; p = 0.019). The main contributors to fluids were nutritional compounds (31%), IV drugs (30%), and volume substitution (17%). Conclusions: Our study demonstrates a significant association of fluid intake but not fluid balance with hospital complications and poor functional outcome in subarachnoid hemorrhage patients. A larger prospective study is needed to confirm our results.

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The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage

Abstract: This study revealed inconsistencies in the fluid orders as well as mistakes in the fluid monitoring, which illustrates the difficulties of fluid therapy and reinforces the need for strong evidence-based guidelines for hypervolemic therapy in SAH.

Cited by 5 publications

References 30 publications

Quality of fluid balance charting and interventions to improve it: a systematic review

Quality of fluid balance charting and interventions to improve it: a systematic review

Comparison of the timing of intervention and treatment modality of poor-grade aneurysmal subarachnoid hemorrhage

Fluid Intake But Not Fluid Balance Is Associated With Poor Outcome in Nontraumatic Subarachnoid Hemorrhage Patients

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