Randomized Pilot Trial of Intensive Management of Blood Pressure or Volume Expansion in Subarachnoid Hemorrhage (IMPROVES)

Abstract

This pilot study showed adequate feasibility and excellent retention to follow-up. Given the suggestion of possible worse neurobehavioral outcome with ABP, a larger trial to determine the optimal blood pressure management in this patient population is warranted. (ClinTrials.gov NCT01414894.)

Clinical and experimental aspects of aneurysmal subarachnoid hemorrhage

“…Studies have shown that hypervolemic therapy did not prevent DCI when compared to euvolemia; in fact, hypervolemia may increase the risk pulmonary edema, myocardial ischemia, and cerebral edema . In a randomized trial, prophylactic hypervolemia caused an overall fourfold increase in the risk of adverse events . The current guidelines have shifted toward a more euvolemic approach with main goal of avoiding hypovolemia without volume overload; prophylactic hypervolemia before the development of angiographic vasospasm is not recommended…”

“…44 In a randomized trial, prophylactic hypervolemia caused an overall fourfold increase in the risk of adverse events. 45 The current guidelines have shifted toward a more euvolemic approach with main goal of avoiding hypovolemia without volume overload;…”

Medically induced hypertension, hypervolaemia and haemodilution for the treatment and prophylaxis of vasospasm following aneurysmal subarachnoid haemorrhage: systematic review

“…Of these, reports of studies were considered for inclusion in our review. 15,16,[19][20][21][22][23][27][28][29][30][31][32][33][34] One study was excluded as the treatment group included both those with hypervolaemic fluid supplementation and normovolaemic colloid administration and consequently effects of either of these interventions and consequent physiological changes could not be reliably attributed. 35 Two studies were excluded as the majority of patients in the treatment group had suspected vasospasm whilst those in the control did not.…”

“…[19][20][21][22]28 Four were cohort studies 27,29,30,33 ; for one of these the study protocol was published prospectively. 27 Seven reported 19,20,[27][28][29][30]33 One reported only on cerebral blood flow (CBF), as measured using CT perfusion scanning. 21,22 In six studies, the intervention was introduced as a prophylactic measure.…”

“…They were not included in the analysis as only studies published in the previous 5 years were analysed. Response: we have adjusted the wording of this statement to more accurately reflect this: "Furthermore, we have identified an additional three cohort studies, which, although identified, have not been included in previous systematic reviews 24,25,28,37 . "…”