부산대학교 도서관

Introduction: Aneurysmal subarachnoid hemorrhage (SAH) is a neurosurgical emergency that carries significant morbidities and mortality. Management includes bleeding control and supportive care to minimize secondary brain injuries. Fluid management in this group of patients remains a challenge. This study aims to determine whether early fluid balance can affect functional outcome. Methods: We retrospectively reviewed 140 patients with SAH admitted to intensive care unit (ICU) of Pamela Youde Nethersole Eastern Hospital between January 2011 to December 2016. Data on patients demographics and clinical characteristics were collected, including cumulative 4 days fluid balance, age, mean arterial pressure, maximum glucose, Acute Physiology and Chronic Health Evaluation (APACHE) IV score, Glasgow Coma Scale (GCS), modified Fisher scale, WFNS (World Federation of Neurosurgical Societies) grade, presence of vasospasm and surgical or endovascular management of the aneurysm. The primary outcome was Glasgow Outcome Scale (GOS) at 3 months with GOS 1 to 3 classified as poor outcome and GOS 4 to 5 as good outcome. Secondary outcomes were ventilator days, hospital and ICU length of stay (LOS). Results: One hundred and forty patients were included in the analysis. The median age was 55.5 years. Twenty (14.3%) patients had died. The cumulative 4 days fluid balance was associated with poor outcome in the univariate analysis (p=0.002). In the logistic regression analysis, it is not independently associated with poor outcome. Age, APACHE IV score, and modified Fisher scale 4 were independent predictors of poor outcome. The cumulative 4 days fluid balance was not associated with secondary outcomes: ICU LOS (Spearman's rho correlation coefficient, r=0.152, p=0.073), hospital LOS (r=0.126, p=0.137) and ventilator days (r=0.252, p=0.003). Conclusion: In this cohort of patients, age, APACHE IV, and modified Fisher scale 4 were independent predictors of poor functional outcome in patients with SAH.