Beyond the waveform: FloTrac for brain protection and DCI in aSAH

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Aneurysmal subarachnoid haemorrhage (aSAH) (n=68). Intervention: FloTrac-guided goal-directed fluid therapy (GDT) vs. Conventional CVP-guided fluid management (crystalloid infusions 1500-3000 ml/day targeting CVP 5-8 mmHg). Primary outcome: Incidence of delayed cerebral ischaemia (DCI) (ARR 14.8%, p=0.262).

Q: What does this research mean for the field?

FloTrac-guided goal-directed fluid therapy results in a numerically lower incidence of delayed cerebral ischaemia and reduces angiographic vasospasm compared to central venous pressure-guided management in aneurysmal subarachnoid haemorrhage patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Bhavana Pinnaka

doi:10.6026/973206300225690

September 30, 2026BioinformationOpen Access

Beyond the waveform: FloTrac for brain protection and DCI in aSAH

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Key result

FloTrac-guided goal-directed therapy resulted in a numerically lower incidence of delayed cerebral ischaemia compared to CVP-guided management (17.6% vs 32.4%; ARR 14.8%, P=0.262) in aSAH patients.

Why the study?

Delayed cerebral ischaemia is the leading preventable cause of morbidity after aneurysmal subarachnoid haemorrhage, prompting evaluation of FloTrac-guided goal-directed fluid therapy.

Does FloTrac-guided goal-directed fluid therapy reduce the incidence of delayed cerebral ischaemia over 14 days compared with conventional CVP-guided management in adults with aneurysmal subarachnoid haemorrhage?

Study Design

Type

RCT (n=68)

Randomization

1:1 using a computer-generated allocation sequence

Multicenter

No

Structured PICO

Does FloTrac-guided goal-directed fluid therapy reduce the incidence of delayed cerebral ischaemia over 14 days compared with conventional CVP-guided management in adults with aneurysmal subarachnoid haemorrhage?

P

Population

68 adults (mean age ~54 years, 51.5% female) with radiologically confirmed aneurysmal subarachnoid haemorrhage, free of congestive cardiac failure or severe aortic valvular pathology, followed for 14 days.

I

Intervention

FloTrac-guided goal-directed fluid therapy (GDT) for 14 days, using the Vigileo FloTrac system connected to a radial arterial catheter and a 7Fr internal jugular central venous catheter (calculating CI, SVI, SVV, and SVRI every 20 s). Fluids, vasopressors, and inotropes were titrated in a protocolised fashion to maintain predefined haemodynamic targets (CI 3.0-5.0 L min⁻¹ m⁻²; SVI ≥40 ml m⁻²; SVRI 1700-2400 dyn s cm⁻⁵ m⁻²). Added to standardized aSAH management (bed rest, short-term antifibrinolytic therapy, surgical clipping or endovascular coiling, and oral nimodipine 60 mg every 4 h for 21 days).

C

Comparator

Conventional CVP-guided fluid management for 14 days, consisting of crystalloid infusions of 1500-3000 ml day⁻¹ adjusted according to clinical judgement targeting CVP 5-8 mmHg, and allogeneic blood transfusion when haematocrit fell below 30%. Both groups received standardized aSAH management (bed rest, short-term antifibrinolytic therapy, surgical clipping or endovascular coiling, and oral nimodipine 60 mg every 4 h for 21 days).

O

Outcome

Incidence of delayed cerebral ischaemia (DCI) over 14 days, defined as a composite of: (a) arterial calibre reduction to ≤50% of the admission angiogram on digital subtraction angiography (DSA); or (b) a decrease of ≥2 points on the Glasgow Coma Scale (GCS) or an increase of ≥2 points on the NIH Stroke Scale persisting for ≥8 h, after exclusion of alternative causes.composite

Main Result

Absolute Risk Reduction: 14.8

Absolute Event Rate: 17.6% vs 32.4%

Absolute Risk Reduction: 14.8%

p-value: p=0.262

Limitations

Sample size was insufficient to detect modest differences in clinical endpoints
Single-center design limits generalizability
FloTrac system has recognized accuracy constraints in the presence of cardiac arrhythmias and severe aortic valvular pathology
Follow-up was limited to 14 days, precluding assessment of longer-term neurological outcomes
Sample size was insufficient to detect modest differences in the clinical endpoints reported

Implication

In patients with aneurysmal subarachnoid haemorrhage, FloTrac-guided goal-directed fluid therapy significantly eliminated angiographic vasospasm (0% vs 32.3%, P<0.001) and showed a non-significant numerical reduction in delayed cerebral ischaemia (17.6% vs 32.4%, P=0.262) compared with conventional CVP-guided management.

Abstract

Delayed cerebral ischaemia is the leading preventable cause of morbidity after aneurysmal subarachnoid haemorrhage and this study evaluated FloTrac-guided goal-directed fluid therapy. A prospective randomized trial enrolled 68 patients assigned to conventional CVP-guided management (n=34) or FloTrac-guided therapy (n=34), with delayed cerebral ischaemia as the primary outcome. Delayed cerebral ischaemia occurred less often with FloTrac-guided therapy (17.6% vs. 32.4%), while angiographic vasospasm was absent in the FloTrac group (0% vs. 32.3%; P<0.001). FloTrac-guided therapy produced better functional recovery, fewer readmissions and shorter ICU and hospital stays, although most differences were not statistically significant. Thus, FloTrac-guided goal-directed therapy showed clinically meaningful benefits and this may improve neurological outcomes after aneurysmal subarachnoid haemorrhage.

Discussion

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Cite This Study

Bhavana Pinnaka (2026) conducted an RCT in Aneurysmal subarachnoid haemorrhage (aSAH) (n=68). FloTrac-guided goal-directed fluid therapy (GDT) vs. Conventional CVP-guided fluid management (crystalloid infusions 1500-3000 ml/day targeting CVP 5-8 mmHg) was evaluated on Incidence of delayed cerebral ischaemia (DCI) (ARR 14.8%, p=0.262). FloTrac-guided goal-directed therapy resulted in a numerically lower incidence of delayed cerebral ischaemia compared to CVP-guided management (17.6% vs 32.4%; ARR 14.8%, P=0.262) in aSAH patients.

synapsesocial.com/papers/6ae28e0ecbadf70daf6c407d https://doi.org/10.6026/973206300225690

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Beyond the waveform: FloTrac for brain protection and DCI in aSAH

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Beyond the waveform: FloTrac for brain protection and DCI in aSAH

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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