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[Optimal hypervolemic therapy for symptomatic vasospasm].

M Shimoda1, S Oda, M Hidaka

  • 1Department of Neurosurgery, Tokai University School of Medicine.

No Shinkei Geka. Neurological Surgery
|January 1, 1991
PubMed
Summary
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Optimized hemodynamic therapy (OHT) effectively reversed neurological deficits in patients with symptomatic vasospasm after subarachnoid hemorrhage. This approach improved outcomes compared to conventional hypervolemic therapy.

Area of Science:

  • Neurosurgery
  • Critical Care Medicine
  • Neurology

Context:

  • Symptomatic vasospasm (SV) is a critical complication following aneurysmal subarachnoid hemorrhage (SAH).
  • Effective management of SV is crucial for improving patient outcomes.
  • Hemodynamic monitoring and manipulation are key in treating post-SAH complications.

Purpose:

  • To evaluate the efficacy of an optimized hemodynamic therapy (OHT) protocol for symptomatic vasospasm (SV) post-aneurysmal subarachnoid hemorrhage (SAH).
  • To compare OHT with conventional hypervolemic therapy (CHT) in managing SV.
  • To determine optimal hemodynamic parameters for reversing neurological deficits in SV patients.

Summary:

  • Thirty-five patients with SV post-SAH were managed with OHT, involving targeted increases in pulmonary wedge pressure (Pcwp) and/or central venous pressure (CVP) to reverse neurological deficits.

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  • Neurological deficits were reversed in 74% of patients with immediate improvement after volume expansion.
  • Optimal hemodynamic targets were generally Pcwp 10-15 mmHg and CVP below 11 cmH2O, though some patients required CVP below 7 cmH2O for reversal.

    • Impact:

    • OHT resulted in good outcomes in 80% of patients, with 74% showing immediate improvement.
    • Motor function at discharge was significantly improved in all patients treated with OHT.
    • This study suggests OHT offers a superior approach to CHT for managing symptomatic vasospasm, leading to better patient recovery.