Temporal Profiles of Cerebral Perfusion Pressure After Subarachnoid Hemorrhage

Abstract

Introduction Insufficient cerebral perfusion pressure (CPP) after aneurysmal subarachnoid hemorrhage (aSAH) can impair cerebral blood flow (CBF). We examined the temporal profiles of CPP change and tested whether these profiles were associated with delayed cerebral ischemia (DCI). Method CPP values were retrospectively reviewed for 238 subjects. Intracranial pressure and mean arterial pressure values were obtained every 2 hours for 14 days. Induced hypertension was utilized to prevent vasospasm. The linear and quadratic CPP change over time were tested using growth curve analysis. Multivariable logistic regression was utilized to examine the association between DCI and percentages of CPP values >110, >100, <70, and <60 mmHg. DCI was defined as neurological deterioration due to impaired CBF. Results Between-subjects differences accounted for 39% of variation in CPP values. There was a significant linear increase in CPP values over time (β =0.06, SE=0.006, p<0.001). The covariance (τ01 = -0.52, SE=0.09, p<0.001) between initial CPP and linear parameter was negative, indicating subjects with high CPP on admission had a slower rate of increase whereas those with low CPP had a faster rate of increase. For every 10% increase in the proportion of CPP>100 mmHg or >110 mmHg, the odds of DCI increased by 1.21 and 1.43, respectively (p<.05). Conclusions The longer the time patients spent with high CPP, the greater the odds for DCI. When used prophylactically, induced hypertension contributes to higher CPP values. Based on the CPP trends and correlations observed, induced hypertension may not confer expected benefits in patients with aSAH.

Effects of clinical nursing pathway on postoperative satisfaction and quality of life of patients with subarachnoid hemorrhage

“…Patients with high ADL score, their autonomy is higher, and corresponding SS-QOL level can be improved. Some other studies showed that, 13,14 CNP can improve the GCS score of patients with cerebral hemorrhage, improve their GOS score and cognitive function, and lower the incidence of POCD.…”

Therapeutic evaluation of a patient with ruptured intracranial aneurysm without subarachnoid hemorrhage by CT imaging: a case report

“…Because aneurysm rupture is usually combined with IPH or IVH and SDH, intracranial pressure of such patients is relatively higher compared to patients with simple SAH. Moreover, some patients may lose treatment opportunity due to deteriorated condition caused by sharp increase in intracranial pressure, and therefore, their prognosis may become much worse compared to patients with simple SAH [ 2 , 3 ]. The patient in this study had hematoma in the left temporal lobe without SAH, which was confirmed by head CT scan at the time of admission.…”