Management of eight cases of subarachnoid hemorrhage using transpulmonary thermodilution during clazosentan therapy

IF 0.4 Q4 CLINICAL NEUROLOGY Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-02-08 DOI:10.1016/j.inat.2025.101997

Hiroto Iyota , Yasumasa Kawano , Hironori Fukumoto , Takato Tajiri , Mitsutoshi Iwaasa , Sinichi Morimoto , Yoshito Izutani , Shintaro Yamasaki , Kazuya Yamauchi , Hiroki Hatomoto , Hiroshi Abe , Yoshihiko Nakamura

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Abstract

Clazosentan, an endothelin receptor antagonist, is used to prevent delayed neurological deterioration in patients with subarachnoid hemorrhage due to ruptured cerebral aneurysms. However, fluid management presents challenges. This single-center case series presents the findings from eight patients undergoing fluid management using transpulmonary thermodilution while receiving clazosentan. The median age of the patients was 49 years (interquartile range: 45.5–63.5), and four (50 %) were male. The median World Federation of Neurosurgical Societies classification was 5 (interquartile range: 2–5), and the median Fisher classification was 3 (interquartile range: 3). During clazosentan treatment, the median global end-diastolic volume index based on transpulmonary thermodilution remained at 715.5 ml/m² (interquartile range: 643–788). No ischemic neurological deficits, bilateral pulmonary edema, and pleural effusion were observed. Strict fluid management using transpulmonary thermodilution might prevent the complications associated with clazosentan.

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