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Báo cáo y học: " Pulmonary edema and blood volume after aneurysmal subarachnoid hemorrhage: a prospective observational study"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Pulmonary edema and blood volume after aneurysmal subarachnoid hemorrhage: a prospective observational study. | Hoff et al. Critical Care 2010 14 R43 http ccforum.eom content 14 2 R43 c CRITICAL CARE RESEARCH Open Access Pulmonary edema and blood volume after aneurysmal subarachnoid hemorrhage a prospective observational study Reinier G Hoff1 Gabriel JE Rinkel2 Bon H Verweij3 Ale Algra2 4 Cor J Kalkman1 Abstract Introduction Pulmonary edema PED is a severe complication after aneurysmal subarachnoid hemorrhage SAH . PED is often treated with diuretics and a reduction in fluid intake but this may cause intravascular volume depletion which is associated with secondary ischemia after SAH. We prospectively studied intravascular volume in SAH patients with and without PED. Methods Circulating blood volume CBV was determined daily during the first 10 days after SAH by means of pulse dye densitometry. CBV of 60-80 ml kg was considered normal. PED was diagnosed from clinical signs and characteristic bilateral pulmonary infiltrates on the chest radiograph. We compared CBV cardiac index and fluid balance between patients with and without PED with weighted linear regression taking into account only measurements from the first day after SAH through to the day on which PED was diagnosed. Differences were adjusted for age bodyweight and clinical condition. Results In total 102 patients were included 17 of whom developed PED after a mean of 4 days after SAH. Patients developing PED had lower mean CBV 56.6 ml kg than did those without PED 66.8 ml kg . The mean difference in CBV was -11.3 ml kg 95 CI -16.5 to -6.1 adjusted mean difference -8.0 ml kg 95 CI -14.0 to -2.0 . After adjusting no differences were found in cardiac index or fluid balance between patients with and without PED. Conclusions SAH patients developing pulmonary edema have a lower blood volume than do those without PED and are hypovolemic. Measures taken to counteract pulmonary edema must be balanced against the risk of worsening hypovolemia. Trial registration NTR1255. Introduction Pulmonary edema PED is a severe .