The following is a summary of “Association of Fluid Balance and Hemoglobin Decline With Neurological Outcome After Aneurysmal Subarachnoid Hemorrhage,” published in the September 2024 issue of Critical Care by Truckenmueller et al.

Researchers conducted a retrospective study to assess the association between fluid balance and hemoglobin decline with secondary infarctions and neurologic effects in patients with aneurysmal subarachnoid hemorrhage (aSAH).

They analyzed the use of prophylactic lumbar drains in patients with aSAH treated in ICUs at 19 hospitals in Germany, Switzerland, and Canada between January 2011 and 2016, from which 287 patients were enrolled in the Earlydrain trial. Still, only 237 with full information on daily hemoglobin and balance values were included in this secondary analysis. Fluid balance management and hemoglobin levels during the initial 8 days post-aSAH were recognized as thresholds associated with negative outcomes, and the impact of thresholds on secondary infarctions and 6-month neurologic outcome was estimated by the modified Rankin Scale (mRS).

The results showed patients with adverse outcomes after 6 months (mRS > 2) exhibited a decline in hemoglobin levels and improved cumulative fluid balance. An effective inverse relationship was found between fluid balance and hemoglobin decline. The unfavorable outcome thresholds were 10.4 g/dL for hemoglobin and 4,894 mL for cumulative fluid balance within the first 8 days. In multivariable analysis, fluid balance remained linked with unfavorable outcomes while the impact of hemoglobin levels was reduced. Fluid balance, rather than hemoglobin, was related to secondary infarctions, with the effect being significant after applying inverse probability of treatment weighting, and the association of Transfusion with unfavorable outcomes was identified. 

They concluded that increased fluid balance and a slight decrease in hemoglobin levels are the primary factors contributing to outcomes in patients with aSAH. 

Source: journals.lww.com/ccmjournal/fulltext/2024/09000/association_of_fluid_balance_and_hemoglobin.7.aspx