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Real-Time Monitoring of Neurocritical Patients with Diffuse Optical Spectroscopies
Published on: November 19, 2020
Fluid responsiveness and brain tissue oxygen augmentation after subarachnoid hemorrhage
Pedro Kurtz1, Raimund Helbok, Sang-Bae Ko
1Division of Critical Care Neurology, Department of Neurology, Columbia University, Milstein Hospital 8 Center, 177 Fort Washington Ave, New York, NY, 10032, USA, kurtzpedro@mac.com.
Neurocritical Care
|October 1, 2013
Summary
Fluid bolus resuscitation that increases cardiac index (CI) can improve brain oxygenation in subarachnoid hemorrhage (SAH) patients. Stroke volume variation effectively predicts these responses.
Area of Science:
- Neurocritical care
- Intensive care medicine
- Cerebrovascular physiology
Background:
- Subarachnoid hemorrhage (SAH) poses significant risks to cerebral oxygenation.
- Optimizing fluid management is crucial in SAH patient care.
- Understanding the impact of fluid challenges on brain tissue oxygen pressure (PbtO(2)) is essential.
Purpose of the Study:
- To investigate the relationship between cardiac index (CI) response to fluid challenges and PbtO(2) changes in SAH patients.
- To determine if fluid resuscitation improves cerebral oxygenation.
- To evaluate the predictive value of stroke volume variation.
Main Methods:
- Prospective observational study in a neurological intensive care unit.
- Multimodality monitoring of CI, intracranial pressure (ICP), and PbtO(2) in 10 SAH patients.
- Analysis of 57 fluid challenges using logistic regression and generalized estimating equations.
Main Results:
- 47% of fluid boluses resulted in a ≥10% increase in CI.
- CI responders showed significantly greater increases in PbtO(2) compared to non-responders.
- CI response was independently associated with PbtO(2) response (aOR 21.5, P=0.03).
- Stroke volume variation >9% predicted both CI and PbtO(2) response (AUC 0.86 and 0.81).
Conclusions:
- Fluid resuscitation augmenting CI can enhance cerebral oxygenation in SAH.
- Stroke volume variation is a valuable tool for guiding fluid management in these patients.
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