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      Focal Cerebral Ischemia in Rats: Effect of Hemodilution with α-α Cross-Linked Hemoglobin on CBF

      , , , 1 , 2 ,
      Journal of Cerebral Blood Flow & Metabolism
      Springer Nature

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          FUNDAMENTAL IMPORTANCE OF ARTERIAL OXYGEN CONTENT IN THE REGULATION OF CEREBRAL BLOOD FLOW IN MAN

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            Insulin effects on monovalent cation transport and Na-K-ATPase activity

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              Custom-tailored hemodilution with albumin and crystalloids in acute ischemic stroke.

              Hemodilution in the acute phase of ischemic stroke is still controversial. Multicenter studies have failed to demonstrate any benefit. The present study focuses attention on analysis of circulation in stroke and on individual restabilization of circulation. The Amsterdam Stroke Study is a prospective, single-center, randomized clinical trial (n = 300). Normovolemic hemodilution is accomplished in a customized procedure by administration of 20% albumin plus crystalloids under hemodynamic and rheological monitoring in the acute phase of stroke. All patients receive general intensive care treatment and monitoring with a pulmonary artery catheter. This custom-tailored fluid therapy is guided on the basis of a target pulmonary capillary wedge pressure (12 +/- 3 mm Hg) and hematocrit (0.32 +/- 0.02). The control group receives only customized rehydration by infusion of crystalloids. We obtained significant (p less than 0.05) reduction in mortality at 3 months (from 27% to 16%) and an increase in independence at home (from 35% to 48%) after viscosity reduction by means of hemodilution with albumin in the subgroup with a hematocrit less than 0.45 (n = 201) (specific viscosity effect). We also obtained a significant (p less than 0.005) reduction in mortality at 3 months (from 27% to 8%) and an increase in independence (from 35% to 59%) after only rehydration with crystalloids in the subgroup with overt dehydration (hematocrit greater than or equal to 0.45; n = 51) as compared with the normal-hematocrit group without signs of dehydration (hematocrit less than 0.45; n = 103) (specific rehydration effect). This study may provide an explanation for the failures in former hemodilution trials and may re-establish proper hemodilution and rehydration as a valuable therapy in the acute phase of stroke, thus reducing mortality and improving independence after 3 months.
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                Author and article information

                Journal
                Journal of Cerebral Blood Flow & Metabolism
                J Cereb Blood Flow Metab
                Springer Nature
                0271-678X
                1559-7016
                June 29 2016
                November 1992
                June 29 2016
                November 1992
                : 12
                : 6
                : 971-976
                Affiliations
                [1 ] VA Medical Center, San Diego
                [2 ] University of California at San Diego, La Jolla, California, U.S.A.
                Article
                10.1038/jcbfm.1992.134
                30c860f4-31fb-4efa-9216-84328aab06cd
                © 1992

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