A randomized controlled study of intravenous fluid in acute ischemic stroke

Area of Science:

• Neurology
• Critical Care Medicine
• Emergency Medicine

Background:

• Acute ischemic stroke is a leading cause of long-term disability.
• Management of fluid balance in acute stroke is crucial but not fully understood.
• Previous guidelines have varied regarding intravenous fluid administration in stroke patients.

Purpose of the Study:

• To compare outcomes in acute ischemic stroke patients receiving intravenous fluids versus those who did not.
• To assess the safety and potential efficacy of intravenous fluid administration in this patient population.

Main Methods:

• Prospective, multicenter, randomized, open-label trial with blinded outcome assessment.
• 120 acute ischemic stroke patients (NIHSS 1-18, no dehydration) were randomized.
• Intervention groups: 0.9% NaCl at 100ml/h for 72 hours or no intravenous fluid.

Main Results:

• Study prematurely discontinued due to excess early neurological deterioration in the non-IV fluid group (15% vs 3.3%, p=0.02).
• No significant difference in primary efficacy outcome (NIHSS≤4 at day 7): 83.3% vs 86.7%.
• Predictors of deterioration included higher NIHSS, glucose, and pulse rate.

Conclusions:

• 0.9% NaCl at 100ml/h for 72 hours appears safe in acute ischemic stroke.
• Intravenous fluid administration may be associated with reduced neurological deterioration.
• Findings support considering IV fluids for selected acute ischemic stroke patients (NIHSS < 18).