Electrolyte and Fluid Disturbances in Subarachnoid Hemorrhage and Traumatic Brain Injury

Study Overview
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Brief Summary
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During the course of their acute illness patients with subarachnoid hemorrhage and severe traumatic brain injury often develop disturbances in their fluid balance and electrolyte homeostasis. These shifts are associated with worse outcome and increased morbidity. The aim of this observational study is to systematically analyze the incidence, characteristics, potential diagnostic markers and predisposing factors of such disturbances. The investigators hypothesize that many disturbances cannot be classified with a standard diagnostic approach and that variable fluid management contributes to their pathophysiology. Patients will be closely monitored clinically and the exact fluid and electrolyte balances will be recorded. Treatment decisions are within the bedside physicians responsibility. Baseline fluid management is standardised. No interventions are planned. The observation period equal the duration of ICU stay.

Detailed Description
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Background Electrolyte disturbances and fluid shifts are common in patients with subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI). They usually have a rapid onset with impact on morbidity (possibly mortality) and length of stay. So far the understanding of underlying pathophysiologies and the contribution of iatrogenic influences is not fully understood. Only limited evidence and data on classification, management and outcome of patients exists. Objective To describe the incidence, characteristics and duration of sodium and fluid disturbances in patients with SAH or TBI. To document exact fluid and electrolyte management To evaluate predisposing factors and potential predicting biomarkers such as natriuretic peptides, renin-aldosterone system. Methods Prospective systematic observational study with 50 patients in the SAH group and 50 patients in the TBI group. 8hourly clinical assessment, blood and urin samples. Defined trigger points for additional measurements. Continuous fluid balance documentation Daily measurement of natriuretic peptides, aldosterone and renin

Official Title
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Disturbances of the Sodium and Fluid Balance in Patients With Severe Traumatic Brain Injury and Non-traumatic Subarachnoid Hemorrhage. A Systematic Observational Study

Conditions
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Electrolyte Disturbances, Subarachnoid Hemorrhage, Traumatic Brain Injury, Natriuretic Peptides

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: non-traumatic subarachnoid hemorrhage severe traumatic brain injury (GCS<9) Exclusion Criteria younger than 18 years time to admission after injury or bleed more than 7days death expected in less than 12hours

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 1<br>Patients with non-traumatic subarachnoid hemorrhage | |
| 2<br>Patients with severe traumatic brain injury | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of sodium-fluid disturbances |  | 14 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Type of sodium abnormality |  | 14 days | 
| Haemodynamic changes, 8hourly urine output, 8hourly fluid and sodium balance, changes in fluid management by treating doctors associated with sodium disturbances | We measure all parameters for multivariate analysis to find common predictors for sodium and fluid balance disturbances in these patients | 14 days | 
| Associated changes in natriuretic peptide levels |  | 14 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Electrolyte disturbances, Fluid balance, subarachnoid hemorrhage, traumatic brain injury, Cerebral salt wasting, SIADH, Diabetes insipidus