Fluid Balance Monitoring for Adults With Aneurysmal Subarachnoid Hemorrhage

The challenges of hypervolemic therapy in patients after subarachnoid haemorrhage

“…Electronic bedside charts can potentially reduce these errors [22]. It has been suggested that fluid chart completeness strategies should include clear departmental guidelines, signatures on the nursing documentation and hypervolemic therapy revisions in other NICU/NHDU departments [4]. Problems with documenting the fluid balance are relevant not only to NICU but also to other ICUs [23] and our study emphasised a significant difference in fluid chart completion between the NICU and the NHDU.…”

“…Furthermore, there are no published guidelines for the diagnosis and treatment of CV [17]. Moreover, hypervolemia and hypertension are related to the complications, including cardiopulmonary failure, renal dysfunction, pulmonary oedema, exacerbation of cerebral oedema or rupture of the partially-secured aneurysm [4,14,[18][19][20]. If administered to inappropriately selected patients, the hypervolemic therapy may lead to a prolonged stay at an intensive care and poor neurological outcomes [20].…”

“…The clinical signs of neurological deterioration are associated with delayed cerebral ischaemia (DCI), which may be the consequence of CV [3]. Hypovolemia is one of the factors responsible for lowering brain perfusion, correlated with DCI and CV development after SAH [4]. Healthy humans need two litres of water per day [5], but after SAH the daily fluid intake should increase to 3.0-3.5 l [4].…”

“…For this reason, the unproven benefits of the triple-H therapy should outweigh the potential complications. Furthermore, the current recommendations for hypervolemic therapy in SAH are based on low-level evidence, are regarded as difficult to follow in case of conscious patients with oral fluid intake and need further study [4].…”

“…Hypovolemia is one of the factors responsible for lowering brain perfusion, correlated with DCI and CV development after SAH [4]. Healthy humans need two litres of water per day [5], but after SAH the daily fluid intake should increase to 3.0-3.5 l [4]. Hypertensive hypervolemic hemodilution (triple-H therapy) is a simple treatment concept, which is widely used for the prevention and treatment of CV after SAH and thus to reduce DCI rate [6][7][8].…”