Effect of hyperdynamic therapy by albumin infusion on patients with neurological deficits associated with cerebral vasospasm

Abstract

The present study was designed to define the effect of hyperdynamic state produced by infusion of a large amount of human albumin upon neurological manifestations caused by cerebral vasospasm. No other drugs which have vasomotor effects were administered.
Eight patients, including six preoperative patients, who developed neurological deficits associated with angiographically proven cerebral vasospasm were subjected to this study.
Standard dose of albumin infused in this series was 1.5 g/kg/day to 2.0. Duration of the treatment ranged from 6 days to 16 days with an average of 10 days. Average amount of fluid infused during the treatment was 3, 200 ml/day.
During the therapy, Swan·Ganz catheter was employed to monitor intravascular volume and cardiac function. Colloid. osmotic pressure (COP) was measured with IL 186 oncometer at regular interval. Intracranial pressure was monitored continuously by subdural balloon method.
All the cases showed marked improvement of the neurological status following to the treatment. Finally, seven of the eight cases recovered completely without any neurological deficits.
During this hyperdynamic treatment, COP elevated significantly, which led to hypervolemia. Cardiac index increased markedly while systemic arterial pressure remained unchanged. No elevation of intracranial pressure was observed by the infusion of a large amount of albumin. None of the patients developed cardiac or pulmonary dysfunction despite of marked increase of intravascular volume estimated by significant elevation of cardiac index and pulmonary artery wedge pressure.
The authors believe that the hyperdynamic treatment by giving only a large amount of albumin is the most effective and a safe method in treating neurological manifestations caused by vasospasm due to subarachnoid hemorrhage.