Challenge of intravascular volume assessment in acute ischemic stroke.

Authors

Joseph B. Miller MD, Henry Ford HospitalFollow
Alexander Lee, Henry Ford Health
Julian P. Suszanski, Henry Ford HealthFollow
Madison Tustian
Jessica L. Corcoran, Henry Ford HealthFollow
Steven Moore, Henry Ford Health
Lauren Rodriguez
Christopher A. Lewandowski, Henry Ford HealthFollow

Recommended Citation

Miller JB, Lee A, Suszanski JP, Tustian M, Corcoran JL, Moore S, Rodriguez L, and Lewandowski CA. Challenge of intravascular volume assessment in acute ischemic stroke. Am J Emerg Med 2018.

Document Type

Article

Publication Date

6-1-2018

Publication Title

The American journal of emergency medicine

Abstract

INTRODUCTION: Retrospective data indicates that dehydration in acute ischemic stroke patients may be common, even though these patients frequently have elevated blood pressure. We sought to evaluate clinical and laboratory measures of intravascular volume status compared to more objective measures using ultrasound measurements of the inferior vena cava (IVC).

METHODS: This was a prospective observation study of acute ischemic stroke patients in the emergency department. Patients with NIH stroke scale ≥4 within 12 h of symptom onset were included. A trained ultrasonographer performed bi-dimensional imaging of the IVC with passive respiration to determine the percent inspiratory collapse and maximum diameter. We defined low intravascular volume as >50% IVC collapse and a maximal diameter < 2.1 cm. Analysis was limited to patients with confirmed ischemic stroke.

RESULTS: There were 42 patients, of whom 31 had confirmed acute ischemic stroke. The mean age was 65 ± 15 years, 52% were female, and 71% were hypertensive. The median NIH stroke scale score was 7 (IQR 5-15). Based on IVC ultrasound, low intravascular volume was present in 63% (95% CI 44-80%) of patients. A higher proportion of hypertensive patients had low intrasvascular volume (72% vs. 33%). There was poor correlation between IVC assessment of intrasvascular volume and blinded clinician assessment or laboratory markers of dehydration.

CONCLUSION: The majority of ED acute ischemic stroke patients in this sample were hypertensive and demonstrated low intravascular volume based on IVC ultrasound.

Medical Subject Headings

Acute Disease; Aged; Blood Pressure; Blood Volume Determination; Brain Ischemia; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Ultrasonography; Vena Cava, Inferior

PubMed ID

29395763

Volume

36

Issue

6

First Page

1018

Last Page

1021