[Change of plasma volume on patients treated by induced hypertension therapy for vasospasm]

Plasma volume, central venous pressure and water balance of 24 patients were measured about 1st and 2nd week after early operation for the ruptured aneurysms. All of the patients had been treated by induced hypertension therapy for delayed vasospasm successfully. Plasma volume was measured by RI method using RISA. The average of plasma volume of 16 patients was 58.3 +/- 6.0 ml/kg. This group had 200 ml of 25% albumin every day. It was 48.2 +/- 6.2 ml/kg on 8 patients without albumin. The average of CVP was 11.3 +/- 2.2 cm on the albumin group. It was 5.3 +/- 1.5 cm on the other group. The value of plasma volume and CVP was higher statistically on the albumin group than the other group. Water balance was positive on about half of the albumin group. It was negative on the other group. Three patients of the albumin group had pulmonary edema.

The state of patient's hydration is not hypovolemic, as far as the induced hypertension therapy is possible, even though patient's CVP is low and water blance is negative. Albumin lets the plasma volume increase easily. Therefore, the risk of pulmonary edema may rise when only unreliable CVP is used for the monitoring of plasma volume. Plasma volume measurement is indispensable to the monitoring of fluid management for vasospasm and plasma volume should be aimed at 55-60 ml/kg.