Long-Term Outcome Call into Question the Benefit of Positive Fluid Balance and Colloid Treatment After Aneurysmal Subarachnoid Hemorrhage

High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction

“…10 First, increased "fluid throughput" may cause fluids to accumulate in the interstitial space when the blood-brain barrier is damaged, which may impede local oxygen diffusion to neurons. [19][20][21] Second, hemodilution as a consequence of fluid loading may decrease shear stress in the cerebral arteries, which may be detrimental to the integrity of the blood-brain barrier, 22 and lower Hb levels may contribute to DCI due to decreased oxygen transport capacity of the blood, in line with our findings. Lastly, in cohort 1, as fluid input increased, fluid loss did not increase equally to match the higher fluid input (data not shown).…”

Fluid management of the neurological patient: a concise review

“…It is intriguing that fluid balances seem less clearly associated with secondary brain injuries than fluid intake (especially after SAH). This may indicate that ‘fluid throughput’ may be harmful [ 1 ], but it is unknown how exactly this may contribute to brain injury. One may hypothesize that even very small amounts of fluid extravasated to the brain extravascular interstitium may have a significant impact on brain compliance in an already ‘tight’ situation, although such small amounts of fluid extravasates may not be detectable in net fluid balances.…”

“…However, fluid management in brain-injured patients has several distinctive features compared with non-brain-injured critically ill patients: (1) fluid tonicity is a more pertinent issue; (2) tissue oedema not only results in oxygen diffusion impairments but may also impair CBF due to the unfavourable volume–pressure characteristics of the intracranial content; (3) fluid management is commonly regarded as ‘basic care’ in brain injury, whereas fluid management in other critically ill patients is commonly guided by haemodynamic monitoring, rendering it ‘intensive care’; and (4) optimising CBF with adequate fluid management seems intrinsically more challenging than systemic circulation, because sophisticated monitoring tools for CBF and cerebral oxygenation are generally less well implemented in clinical practice. These distinctive features of fluid management in brain-injured patients deserve scrutiny, because recent data (both within and outside the area of neurocritical care) suggest that the ‘basic care’ of fluid administration in brain-injured patients may have an impact on outcome [ 1 – 3 ]. This is especially salient because fluid management practices in brain-injured patients are highly variable [ 4 , 5 ], which may partly be caused by the fact that published guideline recommendations on fluid management [ 6 , 7 ] are based on low-grade evidence or may be perceived as imprecise (e.g.…”

Assessment of two prophylactic fluid strategies in aneurysmal subarachnoid hemorrhage: A randomized trial

“…There were some limitations in our study. First, the fluid strategy was based upon invasive blood pressure measurements and daily fluid balance data and no other hemodynamic monitoring (pulse induced contour cardiac output [PiCCo] or central venous pressure monitoring) 22 was used. This might have resulted in inequalities in the fluid status during certain periods of the day, but euvolemia was maintained based on the fluid balance data in all patients.…”