Fluid management in the neurointensive care patient using transcranial doppler ultrasound: Preliminary study

Abstract

BackgroundFluid management in the neurointensive care patient is aimed at maintaining an adequate cerebral blood flow. Recent data suggests that an adequate fluid administration may have an important role on outcome. Materials and methodsin this preliminary study we evaluated the use of mean flow velocity normalization as a parameter to guide fluid therapy in neurointensive care patients. We recruited all patients after craniotomy surgery between September 2016 and August 2017 not septic, without cardiac pathologies or pregnancy, with ages of 42 ± 21 standard deviation (SD) and compared pulse pressure variation (PPV) and middle cerebral artery mean velocity (MCA-MV) using transcranial doppler ultrasound (TDU) to guide fluid therapy. The goal was normalization by age of MCA-MV values using fluid therapy with crystalloids, and the main outcome was mortality rate. Results50 patients were recruited with no significant differences in APACHE-II score and all patients had PPV>15% and low MCA-VM at admission. Hospitalization (55,1 ± 13,8 SD Vs 51,3 ± 15,1 SD) and mechanical ventilation (6,6 ± 7,8 SD vs. 5,4 ± 10,7 SD) days had no significant difference as outcome with P = 0,949 and 0,654 respectively, control patients after PPV normalization who didn't achieve the MCA-MV goal had fatal outcome and according to that mortality was significantly high in the control group with 36% compared with 8% in TDU group with P = 0,017, MCA-MV in control patients with fatal outcome and was significantly lower than those who survived (P < 0,01). ConclusionsMCA-MV normalization by age may be an objective tool to guide fluid therapy in neurointensive care patients, however, a larger outcome study is recommended to confirm this hypothesis.