Association of Dose of Intracranial Hypertension with Outcome in Subarachnoid Hemorrhage

Carra, Giorgia; Elli, Francesca; Ianosi, Bogdan-Andrei; Flechet, Marine; Huber, Lukas; Rass, Verena; Depreitere, Bart; Güiza, Fabian; Meyfroidt, Geert; Citerio, Giuseppe; Helbok, Raimund

doi:10.1007/s12028-021-01221-4

Cited by 24 publications

(21 citation statements)

References 19 publications

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“…Furthermore, other approaches have been made to quantify the effects of intracranial hypertension. For example, the ICP dose, i.e., the combination of ICP intensity and the duration of that episode, has in one recent study been more strongly associated with unfavorable outcome than ICP above certain fixed thresholds [ 4 ]. On balance, despite the negative results in this paper, higher ICP for longer periods of time does seem to exert a negative effect on the brain and worsen outcome.…”

Section: Discussionmentioning

confidence: 99%

Intracranial pressure- and cerebral perfusion pressure threshold-insults in relation to cerebral energy metabolism in aneurysmal subarachnoid hemorrhage

et al. 2022

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Background The aim was to investigate the association between intracranial pressure (ICP)- and cerebral perfusion pressure (CPP) threshold-insults in relation to cerebral energy metabolism and clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH). Methods In this retrospective study, 75 aSAH patients treated in the neurointensive care unit, Uppsala, Sweden, 2008–2018, with ICP and cerebral microdialysis (MD) monitoring were included. The first 10 days were divided into early (day 1–3), early vasospasm (day 4–6.5), and late vasospasm phase (day 6.5–10). The monitoring time (%) of ICP insults (> 20 mmHg and > 25 mmHg), CPP insults (< 60 mmHg, < 70 mmHg, < 80 mmHg, and < 90 mmHg), and autoregulatory CPP optimum (CPPopt) insults (∆CPPopt = CPP-CPPopt < − 10 mmHg, ∆CPPopt > 10 mmHg, and within the optimal interval ∆CPPopt ± 10 mmHg) were calculated in each phase. Results Higher percent of ICP above the 20 mmHg and 25 mmHg thresholds correlated with lower MD-glucose and increased MD-lactate-pyruvate ratio (LPR), particularly in the vasospasm phases. Higher percentage of CPP below all four thresholds (60/70/80//90 mmHg) also correlated with a MD pattern of poor cerebral substrate supply (MD-LPR > 40 and MD-pyruvate < 120 µM) in the vasospasm phase and higher burden of CPP below 60 mmHg was independently associated with higher MD-LPR in the late vasospasm phase. Higher percentage of CPP deviation from CPPopt did not correlate with worse cerebral energy metabolism. Higher burden of CPP-insults below all fixed thresholds in both vasospasm phases were associated with worse clinical outcome. The percentage of ICP-insults and CPP close to CPPopt were not associated with clinical outcome. Conclusions Keeping ICP below 20 mmHg and CPP at least above 60 mmHg may improve cerebral energy metabolism and clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Intracranial pressure- and cerebral perfusion pressure threshold-insults in relation to cerebral energy metabolism in aneurysmal subarachnoid hemorrhage

et al. 2022

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“…Intracranial hypertension after SAH is associated with poor outcomes [30][31][32]. Existing SAH international guidelines [5,16,18] do not provide specific recommendations regarding ICP/CPP monitoring and treatment despite there being several reasons for doing so [33].…”

Section: Icp Monitoring and Intracranial Hypertension Managementmentioning

confidence: 99%

Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)—part 2

Picetti

Barbanera

Bernucci

et al. 2022

J Anesth Analg Crit Care

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Background Questions remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI) to provide clinical guidance regarding this topic. Specifically, in this manuscript (part 2), we aim to provide a list of experts’ recommendations regarding the management of SAH patients in a center with neurosurgical/neuroendovascular facilities after aneurysm treatment. Methods A multidisciplinary consensus panel composed by 24 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different specializations (anesthesia/intensive care, neurosurgery, and interventional neuroradiology) was created. A modified Delphi approach was adopted. Results A total of 33 statements were discussed, voted, and approved. Consensus was reached on 30 recommendations (28 strong and 2 weak). In 3 cases, where consensus could not be agreed upon, no recommendation was provided. Conclusions This consensus provides practical recommendations (and not mandatory standard of practice) to support clinician’s decision-making in the management of SAH patients in centers with neurosurgical/neuroendovascular facilities after aneurysm securing.

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“…These results should be interpreted with caution as all patients in the ICP-guided therapy subgroup experienced intracranial hypertension, which is a well-known determinant of poor outcome in SAH patients, while only 61% had this complication in the ICP/ PbtO 2 group. Unfortunately, we could not assess the "intensity" (the highest ICP value) and "duration" of intracranial hypertension, which have both been shown to predict neurological outcome in this setting 48 . However, brain hypoxia is also a determinant of UO after SAH and deserves further attention in the management of these patients, as for intracranial hypertension.…”

Section: Discussionmentioning

confidence: 99%

Brain tissue oxygenation guided therapy and outcome in non-traumatic subarachnoid hemorrhage

Bogossian

Diaferia

Djangang

et al. 2021

Sci Rep

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Brain hypoxia can occur after non-traumatic subarachnoid hemorrhage (SAH), even when levels of intracranial pressure (ICP) remain normal. Brain tissue oxygenation (PbtO2) can be measured as a part of a neurological multimodal neuromonitoring. Low PbtO2 has been associated with poor neurologic recovery. There is scarce data on the impact of PbtO2 guided-therapy on patients’ outcome. This single-center cohort study (June 2014–March 2020) included all patients admitted to the ICU after SAH who required multimodal monitoring. Patients with imminent brain death were excluded. Our primary goal was to assess the impact of PbtO2-guided therapy on neurological outcome. Secondary outcome included the association of brain hypoxia with outcome. Of the 163 patients that underwent ICP monitoring, 62 were monitored with PbtO2 and 54 (87%) had at least one episode of brain hypoxia. In patients that required treatment based on neuromonitoring strategies, PbtO2-guided therapy (OR 0.33 [CI 95% 0.12–0.89]) compared to ICP-guided therapy had a protective effect on neurological outcome at 6 months. In this cohort of SAH patients, PbtO2-guided therapy might be associated with improved long-term neurological outcome, only when compared to ICP-guided therapy.

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Association of Dose of Intracranial Hypertension with Outcome in Subarachnoid Hemorrhage

Cited by 24 publications

References 19 publications

Intracranial pressure- and cerebral perfusion pressure threshold-insults in relation to cerebral energy metabolism in aneurysmal subarachnoid hemorrhage

Intracranial pressure- and cerebral perfusion pressure threshold-insults in relation to cerebral energy metabolism in aneurysmal subarachnoid hemorrhage

Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)—part 2

Brain tissue oxygenation guided therapy and outcome in non-traumatic subarachnoid hemorrhage

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