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

Abstract

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.

Impact of Early Fluid Balance on Long-Term Mortality in Critically Ill Surgical Patients: A Retrospective Cohort Study in Central Taiwan

“…Similarly, Rass et al recently reported that a higher day 1–2 fluid input, instead of day 1–2 fluid balance, was associated with the outcome, including prolonged mechanical ventilation, early brain oedema, anaemia, delayed cerebral ischemia and 3-month functional status, in 237 patients with non-traumatic subarachnoid haemorrhage enrolled between 2010 and 2016. Notably, in line with our data, Rass et al illustrated daily fluid balance from day-1 to day-15 after the incident of subarachnoid haemorrhage and explicitly demonstrated that fluid balance generally reaches a stable status on approximately day-6/day-7 after the subarachnoid haemorrhage, suggesting the crucial role of fluid balance in critically ill neurological patients [ 32 ]. Unlike increasing studies that have shown a slightly increased comorbidity and mortality rate among critically ill neurological patients with a positive fluid balance in days 1–3, evidence of the impact of fluid balance beyond day-3 is sparse [ 31 , 33 ].…”

International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage

“…As a result, current recommendations state that a negative fluid balance should be avoided in aSAH. In addition, more recent evidence indicates that hypervolemia may also be harmful [31,32].…”

Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage

“…Higher fluid intake in aSAH has been associated with significant complications, such as pulmonary edema, prolonged intubation, DCI, and poor functional outcomes. 225,226 The HIMA-LAIA trial was the first RCT investigating the role of induced hypertension in DCI. The trial did not demonstrate any benefit in the induced hypertension group with a risk ratio for serious adverse events of 2.1 (95% CI, 0.9 to 5.0), although the trial was ended early because of negative results and slow recruitment.…”