TY - JOUR
T1 - Does prophylactic postoperative hypervolemic therapy prevent cerebral vasospasm and improve clinical outcome after aneurysmal subarachnoid hemorrhage?
AU - Capampangan, Dan J.
AU - Wellik, Kay E.
AU - Aguilar, Maria I.
AU - Demaerschalk, Bart M.
AU - Wingerchuk, Dean M.
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2008/11
Y1 - 2008/11
N2 - Background: Delayed cerebral vasospasm is a common cause of morbidity and mortality after acute aneurysmal subarachnoid hemorrhage. Hypovolemia and fluid restriction are risk factors for delayed vasospasm; hypervolemic therapeutic approaches are commonly used in patients with subarachnoid hemorrhage to prevent and to treat cerebral vasospasm. Objective: To determine if postoperative prophylactic hypervolemic therapy prevents cerebral vasospasm and improves clinical outcome in patients with aneurysmal subarachnoid hemorrhage. Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario, structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of vascular neurology. Results: One randomized controlled trial addressed the questions. There was no difference in the incidence of symptomatic cerebral vasospasm (20% each) or clinical outcome at 14 days and 3 months between the hypervolemic and normovolemic groups. Hypervolemic therapy also had no effect on measures of cerebral blood flow. A second quasi-randomized trial reached the same conclusions. Conclusion: Available evidence is insufficient to support use of prophylactic hypervolemic therapy after surgery in patients with aneurysmal subaraclmoid hemorrhage. Although completed studies may be insufficiently sensitive (underpowered) to detect a treatment effect, the magnitude of any as yet undetected benefit of prophylactic hypervolemic therapy is likely modest and its risks have not been systematically evaluated.
AB - Background: Delayed cerebral vasospasm is a common cause of morbidity and mortality after acute aneurysmal subarachnoid hemorrhage. Hypovolemia and fluid restriction are risk factors for delayed vasospasm; hypervolemic therapeutic approaches are commonly used in patients with subarachnoid hemorrhage to prevent and to treat cerebral vasospasm. Objective: To determine if postoperative prophylactic hypervolemic therapy prevents cerebral vasospasm and improves clinical outcome in patients with aneurysmal subarachnoid hemorrhage. Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario, structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of vascular neurology. Results: One randomized controlled trial addressed the questions. There was no difference in the incidence of symptomatic cerebral vasospasm (20% each) or clinical outcome at 14 days and 3 months between the hypervolemic and normovolemic groups. Hypervolemic therapy also had no effect on measures of cerebral blood flow. A second quasi-randomized trial reached the same conclusions. Conclusion: Available evidence is insufficient to support use of prophylactic hypervolemic therapy after surgery in patients with aneurysmal subaraclmoid hemorrhage. Although completed studies may be insufficiently sensitive (underpowered) to detect a treatment effect, the magnitude of any as yet undetected benefit of prophylactic hypervolemic therapy is likely modest and its risks have not been systematically evaluated.
KW - Blood volume
KW - Critically appraised topic
KW - Evidence-based medicine
KW - Hypervolemia
KW - Intracranial vasospasm
KW - Subarachnoid hemorrhage
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U2 - 10.1097/NRL.0b013e31818a0f29
DO - 10.1097/NRL.0b013e31818a0f29
M3 - Article
C2 - 19008746
AN - SCOPUS:57749105227
SN - 1074-7931
VL - 14
SP - 395
EP - 398
JO - Neurologist
JF - Neurologist
IS - 6
ER -