naa a22 4500 510799752 CHVBK 20180411083349.0 cr unu---uuuuu 180411e20131001xx s 000 0 eng 10.1007/s12028-013-9860-z doi (NATIONALLICENCE)springer-10.1007/s12028-013-9860-z The Effects of Fluid Balance and Colloid Administration on Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Propensity Score-Matched Analysis [Elektronische Daten] [George Ibrahim, R. Macdonald] Background: Delayed ischemic neurological deficit (DIND) following aneurysmal subarachnoid hemorrhage (SAH) remains a significant cause of mortality and disability. The administration of colloids and the induction of a positive fluid balance during the vasospasm risk period remain controversial. Here, we compared DIND and outcomes among propensity score-matched cohorts who did and did not receive colloids and also tested the effect of a positive fluid balance on these endpoints. Methods: Exploratory analysis was performed on 413 patients enrolled in CONSCIOUS-1, a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm. Propensity score matching was performed on the basis of age, gender, pre-existing heart conditions, hypertension, nicotine use, World Federation of Neurosurgical Societies scores, aneurysm location, clazosentan treatment, subarachnoid clot burden, and severity of angiographic vasospasm. Inferential statistics were used for group-wise comparisons. Results: One hundred twenty-three subjects were matched (41 received colloids, whereas 82 did not). The covariate balance and propensity score distributions were acceptable. There was no difference between the groups with respect to DIND (17 vs. 22%; p=0.64) or the presence (48 vs. 51%; p=0.71) or volume of delayed infarcts (volume >7.5cm3; 62 vs. 48%; p=0.41). Similarly, no differences were found on multivariate analysis between patients who did and did not have a positive fluid balance, although patients with severe angiographic vasospasm had more delayed infarcts with a negative fluid balance (p=0.01). Among all subjects, the administration of colloids and a positive fluid balance were associated with worse outcomes on the NIHSS (p=0.04) and modified Rankin (p=0.02) scales, respectively. Conclusions: Colloid administration and induction of a positive fluid balance during the vasospasm risk period may be associated with poor outcomes in specific patient groups. Patient selection is of utmost importance when managing the fluid status of patients with aneurysmal SAH. Springer Science+Business Media New York, 2013 Hemodynamic therapy nationallicence HHH nationallicence Fluid balance nationallicence Subarachnoid hemorrhage nationallicence Triple-H nationallicence Vasospasm nationallicence Volume expansion nationallicence ACA : Anterior cerebral artery nationallicence CT : Computed tomography nationallicence DIND : Delayed ischemic neurological deficit nationallicence GOSE : Extended glasgow outcome scale nationallicence HHH : Triple-H (hypertension, hypervolemia, hemodilution) nationallicence ICA : Internal carotid artery nationallicence MCA : Middle cerebral artery nationallicence mRS : Modified rankin scale nationallicence NIHSS : National Institutes of Health Stroke Scale nationallicence SAH : Subarachnoid hemorrhage nationallicence WFNS : World Federation of Neurosurgical Societies nationallicence Ibrahim George Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, M5B 1W8, Toronto, ON, Canada aut Macdonald R. Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, M5B 1W8, Toronto, ON, Canada aut Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 140-149 1541-6933 19:2<140 2013 19 12028 https://doi.org/10.1007/s12028-013-9860-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9860-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ibrahim George Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, M5B 1W8, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Macdonald R. Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, M5B 1W8, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 140-149 1541-6933 19:2<140 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer