hypervolemia_for_vasospasm [Neurosurgery Wiki]

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[[Hypervolemia]] is perhaps the most controversial of the [[HHH]] components. Many centers continue to use hypervolemia, often dictated by the use of central venous and pulmonary artery catheters, despite the lack of evidence that it is beneficial. 

Hypervolemic therapy may, in particular, be associated with high rates of complications, including pulmonary edema, dilutional hyponatremia, coagulopathy, and aneurysm rebleeding
((Kassell NF, Peerless SJ, Durward QJ, Beck DW, Drake CG, Adams HP. Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery. 1982;11:337–343. doi: 10.1227/00006123-198209000-00001)).

One study 
((Lennihan L, Mayer SA, Fink ME, Beckford A, Paik MC, Zhang H, Wu YC, Klebanoff 
LM, Raps EC, Solomon RA. Effect of hypervolemic therapy on cerebral blood flow
after subarachnoid hemorrhage : a randomized controlled trial. Stroke. 2000
Feb;31(2):383-91. PubMed PMID: 10657410.
))
randomized 82 patients to either hypervolemic or euvolemic status, which was maintained to day 14 after aneurysmal rupture. The central venous pressures were higher in the hypervolemic group, but here was no difference in cerebral blood flow or cerebral blood volume and the incidence of vasospasm was 20% in both groups.

Another study found no difference in the incidence of vasospasm or in clinical outcome, but the hospital costs and complication rate were much higher in the patients treated with hypervolemia
((Egge A, Waterloo K, Sjøholm H, Solberg T, Ingebrigtsen T, Romner B.
Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal
subarachnoid hemorrhage: a clinical, prospective, randomized, controlled study.
Neurosurgery. 2001 Sep;49(3):593-605; discussion 605-6. PubMed PMID: 11523669.
)).

There is little doubt to the fact that hypovolemia is detrimental to these patients, but hypervolemia may be detrimental as well 
((Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN,
Duldner JE Jr, Harbaugh RE, Patel AB, Rosenwasser RH; American Heart Association.
Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement 
for healthcare professionals from a special writing group of the Stroke Council, 
American Heart Association. Stroke. 2009 Mar;40(3):994-1025. doi:
10.1161/STROKEAHA.108.191395. Epub 2009 Jan 22. Review. Erratum in: Stroke. 2009 
Jul;40(7):e518. PubMed PMID: 19164800.
)).