Treatment of cerebral vasospasm. Usefulness of Swan-Ganz catheter monitoring of volume expansion.

A practical approach to the treatment of neurological deficits associated with cerebral vasospasm by means of volume expansion and hypertension is illustrated by the management of two patients. In each instance, monitoring of cardiac and volume status was performed with a triple-lumen thermodilution Swan-Ganz catheter to determine what mean pulmonary artery wedge pressure would generate the greatest cardiac output. Intravascular volume was expanded with increased fluids, albumin, and blood. Neurological deficits in both patients were reversed completely. Neither patient developed pulmonary hypoxia, congestive heart failure, pulmonary edema, myocardial infarction, or symptoms of intracranial hypertension.