Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP

Johnson, Ulf; Engquist, Henrik; Lewén, Anders; Howells, Tim; Nilsson, Pelle; Ronne-Engström, Elisabeth; Rostami, Elham; Enblad, Per

doi:10.1007/s00701-017-3139-7

Cited by 21 publications

(21 citation statements)

References 32 publications

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“…Poor neurological outcomes of SAH patients are usually secondary to early brain injury, rebleeding, or delayed cerebral ischemia [1, 8, 9]. Early brain injury is associated with intracranial hypertension [1, 9, 10]. Therefore, early monitoring of intracranial hypertension may allow prediction of neurological outcomes in these patients.…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of optic nerve sheath diameter in patients with subarachnoid hemorrhage

et al. 2019

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Background We evaluated the role of optic nerve sheath diameter (ONSD) using brain computed tomography (CT) in predicting neurological outcomes of patients with subarachnoid hemorrhage (SAH). Methods This was a retrospective, multicenter, observational study of adult patients with SAH admitted between January 2012 and June 2017. Initial brain CT was performed within 12 h from onset of SAH, and follow-up brain CT was performed within 24 h from treatment of a ruptured aneurysm. Primary outcome was neurological status at 6-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). Results Among 223 SAH patients, 202 (90.6%) survived until discharge. Of these survivors, 186 (83.4%) manifested favorable neurological outcomes (GOS of 3, 4, or 5). In this study, the ONSDs in the group of patients with poor neurological outcome were significantly greater than those in the favorable neurological outcome group (all p < 0.01). Intracranial pressure (ICP) was monitored in 21 (9.4%) patients during the follow-up CT. A linear correlation existed between the average ONSD and ICP in simple correlation analysis ( r = 0.525, p = 0.036). Analysis of the receiver operating characteristic curve for prediction of poor neurological outcome showed that ONSD had considerable predictive value ( C -statistics, 0.735 to 0.812). In addition, the performance of a composite of Hunt and Hess grade and ONSD was increasingly associated with poor neurological outcomes than the use of each marker alone. Conclusions ONSD measured with CT may be used in combination with clinical grading scales to improve prognostic accuracy in SAH patients.

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Section: Introductionmentioning

confidence: 99%

The prognostic value of optic nerve sheath diameter in patients with subarachnoid hemorrhage

et al. 2019

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“…In patients with poor-grade SAH, poor neurological outcome is usually secondary to early brain injury or delayed cerebral ischemia 2) . Secondary cerebral injury can occur, that is the additive cerebral injury characterized by an imbalance in postresuscitation cerebral oxygen delivery and use, ultimately culminating in neuronal death 5) . In addition, cerebral autoregulation may be disturbed to different extents and disturbed autoregulation in SAH is associated with delayed cerebral ischemia, vasospasm and unfavorable outcome 5) .…”

Section: Discussionmentioning

confidence: 99%

“…Secondary cerebral injury can occur, that is the additive cerebral injury characterized by an imbalance in postresuscitation cerebral oxygen delivery and use, ultimately culminating in neuronal death 5) . In addition, cerebral autoregulation may be disturbed to different extents and disturbed autoregulation in SAH is associated with delayed cerebral ischemia, vasospasm and unfavorable outcome 5) . Especially, uncontrolled intracranial hypertension results in decreased cerebral blood flow and transient global cerebral ischemia and associated with early brain injury and poor neurological outcome 2,5) .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, cerebral autoregulation may be disturbed to different extents and disturbed autoregulation in SAH is associated with delayed cerebral ischemia, vasospasm and unfavorable outcome 5) . Especially, uncontrolled intracranial hypertension results in decreased cerebral blood flow and transient global cerebral ischemia and associated with early brain injury and poor neurological outcome 2,5) . Therefore, early monitoring of intracranial hypertension may be beneficial in predicting neurological outcomes of the patients with poor-grade SAH.…”

Section: Discussionmentioning

confidence: 99%

“…Uncontrolled intracranial hypertension results in decreased cerebral perfusion and transient global cerebral ischemia 2,5) .…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Value of Optic Nerve Sheath Diameter in Patients with Poor-Grade Subarachnoid Hemorrhages

Ryu

Kim

et al. 2018

J Neurointensive Care

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We evaluated if the optic nerve sheath diameter (ONSD) on brain computed tomography (CT) could be used to predict neurological outcomes of patients with poor-grade subarachnoid hemorrhage (SAH). Methods This was a retrospective and observational study of adult patients with poor-grade SAH admitted January 2012 through June 2017. Initial brain CT was performed within 12 hours from onset of SAH. Follow-up brain CT was performed within 48 hours from onset of SAH and after aneurysmal treatment. The primary outcome was neurological status upon six months later assessed with Glasgow Outcome Scale (GOS, 1 to 5). Results Among 59 patients with poor-grade SAH, survival to discharge was identified in 47 (79.7%) patients. Of these 47 survivors, 39 (66.1%) had good neurological outcomes (GOS of 3, 4 or 5). In this study, initial ONSDs and follow-up ONSDs in the poor neurological outcome group were significantly greater than those in the good neurological outcome group (all p<0.03). The intracranial pressure (ICP) was monitored in only 13 (22.0%) patients at that time of follow-CT scanning. Using simple correlation analysis, there was a linear correlation between ONSD and ICP (ρ=0.683, p=0.010). In ROC curve analysis for prediction of poor neurological outcome, ONSDs and ONSD indices had considerable predictive values (C-statistics: 0.683 to 0.804) and similar predictive performances for poor neurological outcome. Conclusion The ONSDs and ONSD indices measured on CT scanning may be beneficial for predicting neurological outcomes in patients with poor-grade SAH.

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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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Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP

Cited by 21 publications

References 32 publications

The prognostic value of optic nerve sheath diameter in patients with subarachnoid hemorrhage

The prognostic value of optic nerve sheath diameter in patients with subarachnoid hemorrhage

The Prognostic Value of Optic Nerve Sheath Diameter in Patients with Poor-Grade Subarachnoid Hemorrhages

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

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