Abstract
Background: From the variety of factors underlying the ischemia-associated edema formation in large hemispheric stroke (LHS), an increased brain water content during the early phase seems to have a pivotal role for long-lasting tissue damage. However, the importance of the fluid management during the acute phase of LHS has so far not been adequately studied. Therefore, this study explored the association between the fluid balance and functional outcome in patients suffering from LHS.Methods: We analyzed hospital-based medical records of 39 consecutive patients with LHS and decompressive hemicraniectomy. Over the first 10 days after admission, the volumes of all administered fluids were assessed daily and corrected for daily urinary output and insensible loss. Functional outcome at 3 months was assessed with the modified Rankin Scale (mRS) and dichotomized into an acceptable (mRS ≤ 4) vs. a poor outcome (mRS ≥ 5).Results: Compared to patients with a poor functional outcome (n = 19), those with an acceptable outcome (n = 20) were characterized by a significantly lower cumulative net fluid balance at day 5 (1.6 ± 2.5 vs. 3.4 ± 4.4 l), day 7 (2.0 ± 2.9 vs. 4.6 ± 5.2 l), and day 10 (0 ± 2.5 vs. 5.6 ± 6.2 l). In addition to age, only the cumulative net fluid balance at day 10 served as an independent factor for poor functional outcome in multiple regression analyses.Conclusion: These data provide evidence for a critical role of the early phase net fluid balance with respect to the functional outcome after LHS. This observation leads to the hypothesis that patients with LHS might benefit from a more restrictive volume therapy. However, prospective studies are warranted to establish a causal relationship and recommendations for treatment strategies.
Highlights
Acute proximal artery occlusion within the anterior circulation often results in large hemispheric stroke (LHS), especially when approaches that focus on vessel recanalization, i.e., mechanical thrombectomy [1], are not applicable due to given contraindication
Based on the assumption that a reduced energy metabolism might result in less edema formation, hypothermia has been discussed as a potential neuroprotective strategy in patients with LHS
This study aimed to examine the association between fluid management during the acute phase of LHS including decompressive hemicraniectomy and the functional outcome at 3 months
Summary
Acute proximal artery occlusion within the anterior circulation often results in large hemispheric stroke (LHS), especially when approaches that focus on vessel recanalization, i.e., mechanical thrombectomy [1], are not applicable due to given contraindication. Up to 80% of those patients exhibit fatal courses while survivors are permanently affected by severe neurological deficits [4,5,6]. These facts qualify LHS—irrespectively of modern strategies for vessel re-opening—to a complication with high personal and socio-economic burden. Similar findings were already published in a former singlecenter study, while hypothermia as an additional strategy to decompressive hemicraniectomy was here associated with an increased mortality [14]. From the variety of factors underlying the ischemia-associated edema formation in large hemispheric stroke (LHS), an increased brain water content during the early phase seems to have a pivotal role for long-lasting tissue damage.
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