Cerebral ischemia in nontraumatic subarachnoid hemorrhage due to intracranial aneurysms rupture

Introduction. Stroke has a high prevalence and mortality rate. Examining the impact of patient treatment on disease outcomes is particularly important for decision making in clinical practice. Obj'ectives. To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. Materials and methods. A multicenter observational clinical study “REspiratory Therapy for Acute Stroke” (RETAS) was conducted under the aegis of the “Federation of Anaesthesiologists and Reanimatologists” (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. Results. We found that initial hypoxemia in the 28-day period was associated with high mortality (in patients with 20 or more NIH scores) (p = 0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension (in patients with 20 or more NIH scores) (p = 0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIH scores) (p < 0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (p < 0.001). We found that the use of standard respiratory status monitoring scales (CPIS, LIS, etc.) was associated with a decrease in mortality (p < 0.001). Conclusions. We identified risk factors that increase mortality in patients with acute stroke with respiratory support: initial hypoxemia, lack of instrumental monitoring of ICP and monitoring of respiratory status according to standard scales, the use of hyperventilation, as well as volume-controlled ventilation.

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Recovery of cognitive functions and self-service in patients with rupture of cerebral aneurysms

Шетова

Shtadler²,

Grigor’evskij

et al. 2022

РНЖ

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There is no unified management of patients with the consequences of subarachnoid hemorrhage in the long term.Purpose of the study. To study the nature and severity of SAH, the clinical manifestation of hemorrhage, the choice of the intervention technique in the acute period of the disease for the long-term results of the treatment of aneurysms.Materials and methods. In the long-term period, at an average time of 3.5 years after aneurysmal subarachnoid hemorrhage, 100 patients were examined who underwent microsurgical intervention (n = 48), endovascular exclusion of the aneurysm from the bloodstream (n = 14), simultaneous intervention, including microsurgical intervention and extra-intracranial vascular bypass (n = 23), as well as microsurgical intervention followed by the introduction of a fibrinolytic agent into the subarachnoid space (n = 15).Results. Risk factors for unfavorable clinical recovery of patients, as well as the development of cognitive and mental disorders, were: intracerebral hematoma, dislocation syndrome, duration of temporary clipping more than 7 minutes, the volume of intraoperative blood loss of more than 300 ml. The best functional recovery in the long-term period was noted in patients who underwent microsurgical clipping of the aneurysm, supplemented by surgical revascularization (p = 0.003).Conclusion. The results of our study demonstrated the persistence of the consequences of surgical intervention for the rupture of cerebral aneurysms for a long time, which necessitates long-term observation of patients, the development of individual programs of physical and psychological rehabilitation, and clinical examination of persons at high risk.

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Cerebral ischemia in nontraumatic subarachnoid hemorrhage due to intracranial aneurysms rupture

Abstract: The article covers the current concepts of cerebral edema development, the mechanisms of cerebral oxygenation and perfusion impairments, as well as delayed morphological and cognitive disorders in non-traumatic subarachnoid hemorrhage due to the rupture of intracranial aneurysms.

Cited by 3 publications

References 82 publications

Russian multiple-center observational clinical study “Register of respiratory therapy for patients with stroke (RETAS)”: aspects of mechanical ventilation

Russian multiple-center observational clinical study “Register of respiratory therapy for patients with stroke (RETAS)”: aspects of mechanical ventilation

Russian multicenter observational clinical study “Register of respiratory therapy for patients with stroke (RETAS)”: a comparative analysis of the outcomes of stroke during mechanical ventilation

Recovery of cognitive functions and self-service in patients with rupture of cerebral aneurysms

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