Postoperative ICU management of patients after subarachnoid hemorrhage

Gruenbaum, Shaun E.; Bilotta, F.

doi:10.1097/aco.0000000000000111

Cited by 11 publications

(10 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When oxidative stress might play a role [3,28] we demonstrated that RROS was decreased during ischemic strokes [4] and during a preliminary study that resistance to ROS was increased after SAH [6]. Characteristics of cohort recruited for the present study were found very similar to other papers SAH-related considering the sex ratio, risk factors, prognosis or treatment procedures [29,30]. As described earlier we noted that RROS at day 1 after SAH onset was significantly increased, only 4 patients ( 2women) being within the arbitrarily estimated normal range of 1 ± 15%.…”

Section: Discussionsupporting

confidence: 70%

Early evolution of resistance to oxidative stress after sub-arachnoid hemorrhages: A cohort study of 50 patients

Thierry¹,

Rozec²,

Bourcier³

et al. 2018

Anaesth Anaesth

View full text Add to dashboard Cite

Background and purpose:The role of Reactive Oxygen Species (ROS) is suspected during subarachnoid haemorrhage. We analysed the early changes in the resistance to ROS (RROS) as a function of the vital prognosis at Day 15 together with other prognostic markers.Methods: Fifty patients had been successively recruited and RROS has been measured using a new method involving the detection of ROS after a standardised singlet oxygen production at Day 1 (D1), 5 and 10 after SAH. Influence of RROS had been considered as a predictive tool of death at day 15 together with WFNS and Glasgow scoring, C-reactive protein, Protein S100B (P S100B) as well as aneurism location or the occurrence of a vasospasm and patients' history. Results:Resistance to ROS at D1 was in 82% of cases greater than in healthy controls. In case of death a decrease of RROS was noted after D5 when it remained low but stable for others. It correlated with WFNS and Glasgow scoring. These changes correlated also with poor prognosis aneurisms locations and the occurrence of vasospasm. P S100B was an efficient initial marker of prognosis but RROS changes correlated better with survival along with survival time. Conclusion:Resistance to ROS is strongly modified after an SAH and seems to be a metabolic marker of prognosis after an SAH providing additional data to clinical scores or pathologic markers of damages to brain matter. It could be used in the future to monitor real time changes induced by prescribed anti-oxidative medications.

show abstract

Section: Discussionsupporting

confidence: 70%

Early evolution of resistance to oxidative stress after sub-arachnoid hemorrhages: A cohort study of 50 patients

Thierry¹,

Rozec²,

Bourcier³

et al. 2018

Anaesth Anaesth

View full text Add to dashboard Cite

show abstract

“…The morbidity and mortality after aSAH is still very high, although bleeding aneurysms can be secured in almost all cases either by endovascular coiling or with micro-neurosurgical clipping [ 4 ]. The reason for poor clinical outcome after aSAH is the occurrence of multiple post-hemorrhagic complications including cerebral vasospasm (CVS), delayed cerebral ischemia (DCI), hydrocephalus, symptomatic epilepsy, and systemic infections [ 5 , 6 , 7 , 8 , 9 , 10 ]. Delayed cerebral ischemia, a multi-factorial phenomenon, but mainly secondary to CVS, is the main player in the prediction of clinical outcome [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Elevated Systemic IL-6 Levels in Patients with Aneurysmal Subarachnoid Hemorrhage Is an Unspecific Marker for Post-SAH Complications

Chaudhry

Stoffel‐Wagner

Kinfe

et al. 2017

IJMS

View full text Add to dashboard Cite

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is still a fatal and morbid disease, although bleeding aneurysms can be secured in almost all cases. Occurrence of post-SAH complications including cerebral vasospasm, delayed cerebral ischemia, hydrocephalus, epilepsy, and infections are the main determinants of clinical outcome. Hence, it is important to search for early predictors for specific post-SAH complications to treat these complications properly. Both cellular and molecular (cytokines) inflammation play a key role after aSAH during the phase of occurrence of post-SAH complications. Interleukin-6 (IL-6) is a well-known cytokine that has been extensively analyzed in cerebrospinal fluid (CSF) of patients after aSAH, but detailed studies exploring the role of systemic IL-6 in aSAH associated complications and its impact on early clinical outcome prediction are lacking. The current study aims to analyze the systemic IL-6 levels over two weeks after bleeding and its role in post-SAH complications. Methods: We recruited 80 aSAH patients prospectively who underwent peripheral venous blood withdrawal in serum gel tubes. The blood was centrifuged to harvest the serum, which was immediately frozen at −80 °C until analysis. Serum IL-6 levels were quantified using Immulite immunoassay system. Patient records including age, gender, post-SAH complications, aneurysm treatment, and clinical outcome (modified Rankin scale and Glasgow outcome scale) were retrieved to allow different subgroup analysis. Results: Serum IL-6 levels were significantly raised after aSAH compared to healthy controls over the first two weeks after hemorrhage. Serum IL-6 levels were found to be significantly elevated in aSAH patients presenting with higher Hunt and Hess grades, increasing age, and both intraventricular and intracerebral hemorrhage. Interestingly, serum IL-6 was also significantly raised in aSAH patients who developed seizures, cerebral vasospasm (CVS), and chronic hydrocephalus. IL-6 levels were sensitive to the development of infections and showed an increase in patients who developed pneumoniae. Intriguingly, we found a delayed increase in serum IL-6 in patients developing cerebral infarction. Finally, IL-6 levels were significantly higher in patients presenting with poor clinical outcome in comparison to good clinical outcome at discharge from hospital. Conclusion: Serum IL-6 levels were elevated early after aSAH and remained high over the two weeks after initial bleeding. Serum IL-6 was elevated in different aSAH associated complications, acting as a non-specific marker for post-SAH complications and an important biomarker for clinical outcome at discharge.

show abstract

“…Severe acute brain injury is associated with prolonged intensive care unit and hospital stay, permanent disability, low quality of life, and death [ 17 ]. These outcomes depend on both the primary brain injury, which is immediate and irreversible, and the ensuing secondary brain injury, which is potentially reversible [ 18 , 25 – 27 ] and induced by triggers such as hypoxia, hypotension, and inflammation [ 12 , 13 , 18 , 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

“…Aneurysmal subarachnoid haemorrhage, which occurs in approximately 9 persons per 100,000 population-years at risk globally, has a fatality of around 25% with 20% of all patients remaining functionally dependent on help for activities of daily living [ 20 , 30 ]. Early-phase complications such as rebleeding and delayed cerebral ischaemia are important predictors of long-term outcome [ 12 , 31 ]. Early aneurysm closure may prevent rebleeding, but the mechanisms leading to delayed cerebral ischaemia are poorly understood and there is currently no known effective treatment [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Ketamine for critically ill patients with severe acute brain injury: Protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials

et al. 2021

View full text Add to dashboard Cite

Introduction Intensive care for patients with severe acute brain injury aims both to treat the immediate consequences of the injury and to prevent and treat secondary brain injury to ensure a good functional outcome. Sedation may be used to facilitate mechanical ventilation, for treating agitation, and for controlling intracranial pressure. Ketamine is an N-methyl-D-aspartate receptor antagonist with sedative, analgesic, and potentially neuroprotective properties. We describe a protocol for a systematic review of randomised clinical trials assessing the beneficial and harmful effects of ketamine for patients with severe acute brain injury. Methods and analysis We will systematically search international databases for randomised clinical trials, including CENTRAL, MEDLINE, Embase, and trial registries. Two authors will independently review and select trials for inclusion, and extract data. We will compare ketamine by any regimen versus placebo, no intervention, or other sedatives or analgesics for patients with severe acute brain injury. The primary outcomes will be functional outcome at maximal follow up, quality of life, and serious adverse events. We will also assess secondary and exploratory outcomes. The extracted data will be analysed using Review Manager and Trials Sequential Analysis. Evidence certainty will be graded using GRADE. Ethics and dissemination The results of the systematic review will be disseminated through peer-reviewed publication. With the review, we hope to inform future randomised clinical trials and improve clinical practice. PROSPERO no CRD42021210447.

show abstract

Postoperative ICU management of patients after subarachnoid hemorrhage

Cited by 11 publications

References 37 publications

Early evolution of resistance to oxidative stress after sub-arachnoid hemorrhages: A cohort study of 50 patients

Early evolution of resistance to oxidative stress after sub-arachnoid hemorrhages: A cohort study of 50 patients

Elevated Systemic IL-6 Levels in Patients with Aneurysmal Subarachnoid Hemorrhage Is an Unspecific Marker for Post-SAH Complications

Ketamine for critically ill patients with severe acute brain injury: Protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials

Contact Info

Product

Resources

About