Global End-diastolic Volume Is Associated With the Occurrence of Delayed Cerebral Ischemia and Pulmonary Edema After Subarachnoid Hemorrhage

Predictive variables of delayed cerebral ischemia (DCI) and pulmonary edema following subarachnoid hemorrhage (SAH) remain unknown. We aimed to determine associations between transpulmonary thermodilution–derived variables and DCI and pulmonary edema occurrence after SAH. We reviewed 34 consecutive SAH patients monitored by the PiCCO system. Six patients developed DCI at 7 days after SAH on average; 28 did not (non-DCI). We compared the variable measures for 1 day before DCI occurred (DCI day −1) in the DCI group and 6 days after SAH (non-DCI day −1) in the non-DCI group for control. The mean value of the global end-diastolic volume index (GEDI) for DCI day −1 was lower than that for non-DCI day −1 (676 ± 65 vs. 872 ± 85 mL/m2, P = 0.04). Central venous pressure (CVP) was not significantly different (7.8 ± 3.1 vs. 9.4 ± 1.9 cm H2O, P = 0.45). At day −1 for both DCI and non-DCI, 11 patients (32%) had pulmonary edema. Global end-diastolic volume index was significantly higher in patients with pulmonary edema than in those without this condition (947 ± 126 vs. 766 ± 81 mL/m2, P = 0.02); CVP was not significantly different (8.7 ± 2.8 vs. 9.2 ± 2.1 cm H2O, P = 0.78). Although significant correlation was found between extravascular lung water (EVLW) measures and GEDI (r = 0.58, P = 0.001), EVLW and CVP were not correlated (r = 0.03, P = 0.88). Thus, GEDI might be associated with DCI occurrence and EVLW accumulation after SAH. ABBREVIATIONS 95% CI — 95% confidence interval AUC — area under the receiver operating characteristic curve CO — cardiac output CVP — central venous pressure DCI — delayed cerebral ischemia EVLW — extravascular lung water EVLWI — extravascular lung water index GEF — global ejection fraction GEDV — global end-diastolic volume GEDI — global end-diastolic volume index ITBV — intrathoracic blood volume ITTV — intrathoracic thermal volume PVPI — pulmonary vascular permeability index SAH — subarachnoid hemorrhage SVRI — systemic vascular resistance index