• Eiji Shikata, Tetsuya Tamura, Kiyohito Shinno, Yoshihiro Okayama, Naoki Shinohara, Kenji Shimada, Yasuhisa Kanematsu, Keiko T Kitazato, Shinji Nagahiro, and Yasushi Takagi.
• Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan. Electronic address: ninth4kata@yahoo.co.jp.
• World Neurosurg. 2019 Sep 1; 129: e352-e360.

BackgroundAfter aneurysmal subarachnoid hemorrhage (aSAH), crystalloid fluids with a relatively high sodium concentration have been used to maintain the cerebral blood flow. However, the prophylactic delivery of water and sodium by intravenous (IV) infusion will not necessarily improve the prognosis of patients after aSAH, and the excessive supply of water and sodium can negatively affect the outcome. We hypothesized that the delivery of an optimal amount of water and sodium separately might improve the outcome after aSAH.MethodsWe recruited 55 consecutive patients who had undergone clipping or endovascular coil embolization after aSAH. Group 1 (n = 33) received conventional therapy (i.e., prophylactic IV sodium and water [protocol 1]). Group 2 (n = 22) received the optimal amount of water and sodium separately (protocol 2).ResultsThe median total of water and sodium chloride supplied in group 1 was significantly greater than that supplied in group 2 (P < 0.01). The modified Rankin scale score at discharge was 0-2 in 15 patients (95%) in group 2 and 23 patients (55%) in group 1 (P < 0.001). On multivariate logistic regression analysis, the odds ratio for a discharge modified Rankin scale score of 0-2 or 3-6 was significantly associated with the treatment protocol (P < 0.05) and the net fluid balance on days 4-8 (P < 0.05).ConclusionThe separate delivery of optimal amounts of water and sodium could be a promising therapeutic strategy to improve the prognosis after aSAH.Copyright © 2019 Elsevier Inc. All rights reserved.

23 keywords...

hide…