Monitoring intravascular volumes to direct hypertensive, hypervolemic therapy in a patient with vasospasm

Eran Segal; Jeremy D Greenlee; Steven J Hata; Azriel Perel

doi:10.1097/00008506-200410000-00008

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Monitoring intravascular volumes to direct hypertensive, hypervolemic therapy in a patient with vasospasm

Journal article

Peer reviewed

Monitoring intravascular volumes to direct hypertensive, hypervolemic therapy in a patient with vasospasm

Eran Segal, Jeremy D Greenlee, Steven J Hata and Azriel Perel

Journal of neurosurgical anesthesiology, Vol.16(4), pp.296-298

10/2004

DOI: 10.1097/00008506-200410000-00008

PMID: 15557835

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Abstract

The common therapeutic approach to patients, who develop vasospasm following subarachnoid hemorrhage, is usually composed of hypertension, hypervolemia, and hemodilution (HHH). This therapy often leads to cardiopulmonary complications, including significant heart failure and pulmonary edema. We describe a 40-year-old woman who developed vasospasm 8 days after surgery for clipping an aneurysm, following a large subarachnoid hemorrhage. The patient required HHH therapy with a very high blood pressure to optimize her clinical neurologic status, but she started to develop pulmonary edema resulting from this therapy. This manifested as a need for increasing oxygen to maintain a normal arterial saturation. To avoid further hemodynamic compromise, we used a new monitor of cardiac function to measure intravascular volumes and quantify pulmonary edema to help titrate the fluid management of a patient in severe vasospasm. We conclude that monitoring volumes with the PiCCO cardiac monitor can help make clinical decisions in patients requiring HHH. This enables maintaining a hypertensive and hypervolemic state while avoiding cardiopulmonary complications such as heart failure and pulmonary edema. It may also help prevent the need for mechanical ventilation in these situations.

Postoperative Complications - physiopathology

Humans

Blood Volume - physiology

Postoperative Complications - therapy

Vasospasm, Intracranial - complications

Hemodynamics - physiology

Intracranial Aneurysm - surgery

Neurosurgical Procedures

Pulmonary Edema - physiopathology

Vasospasm, Intracranial - physiopathology

Pulmonary Edema - diagnosis

Adult

Female

Hemodilution

Monitoring, Physiologic - instrumentation

Hypertension - therapy

Heart Function Tests

Subarachnoid Hemorrhage - surgery

Details

Title: Subtitle: Monitoring intravascular volumes to direct hypertensive, hypervolemic therapy in a patient with vasospasm
Creators: Eran Segal - Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel. e_segal@sheba.health.gov.il
Jeremy D Greenlee
Steven J Hata
Azriel Perel
Resource Type: Journal article
Publication Details: Journal of neurosurgical anesthesiology, Vol.16(4), pp.296-298
Publisher: United States
DOI: 10.1097/00008506-200410000-00008
PMID: 15557835
ISSN: 0898-4921
eISSN: 1537-1921
Language: English
Date published: 10/2004
Academic Unit: Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
Record Identifier: 9984040577802771

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