The effect of tracheotomy on drug consumption in patients with acute aneurysmal subarachnoid hemorrhage: an observational study

Rosseland, Leiv Arne; Narum, Jon; Stubhaug, Audun; Kongsgaard, Ulf E.; Sorteberg, Wilhelm; Sorteberg, Angelika

doi:10.1186/s12871-015-0029-5

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…Poor grade aSAH patients remain on invasive mechanical ventilatory support as long as needed with respect to intracranial pressure and we perform decompressive craniectomy if ICP is not controllable otherwise. We readily perform early percutaneous tracheotomy in order to ease patient awakening and reduce the use of sedative drugs [42]. Cerebral CT angiography (CTA) is performed the day after aneurysm repair and seven days after the ictus, given that the patient is stable enough to allow transport to the radiological suite.…”

Section: Standard Institutional Asah Management Principlesmentioning

confidence: 99%

Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5

et al. 2020

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Background: Outcome of early, aggressive management of aneurysmal subarachnoid hemorrhage (aSAH) in patients with Hunt and Hess grade V is hitherto limited and we therefore present our results. Methods: Retrospective study analyzing the medical data of 228 aSAH patients in Glasgow Coma Score 3-5 admitted at our hospital during the years 2002-2012. Background and treatment variables were registered. Outcome was evaluated after three and twelve months. Results: We intended to treat 176 (77.2%) patients, but only 146 went on to aneurysm repair. Of 52 patients managed conservatively, 27 had abolished cerebral circulation around arrival and 25 were deemed unsalvageable. One-year overall mortality was 65.8% and most (84.7%) of the fatalities occurred within 30 days. One-year mortality was higher in patients >70 years. Without aneurysm repair, mortality was 100%. After one year, 21.9% of all patients lived independently and 4.8% lived permanently in an institution. Outcome in the 78 survivors (34.2%) was favorable in 64.1% in terms of modified Rankin Scale score 0-2 and 85.9% of survivors were able to live at home. Return to work was low for all 228 patients with 14.0% of those employed prior to the hemorrhage having returned to paid work, and respectively, 26.3% in the subgroup of survivors. Conclusions: Even with aggressive, early treatment, one-year mortality is high in comatose aSAH patients with 65.8%. A substantial portion of the survivors have a favorable outcome at one year (64.1%, corresponding to 21.9% of all patients admitted) and 85.9% of the survivors could live at home alone or aided.

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Section: Standard Institutional Asah Management Principlesmentioning

confidence: 99%

Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5

et al. 2020

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“…We practiced extensive use of cerebrospinal fluid (CSF) drainage, in particular during the first week [9,54]. We performed early tracheostomy in poor-grade sedated and intubated patients [49]. Control with computed tomography angiography (CTA) was performed routinely on day 7 after the ictus to detect vasospasm, respectively on day 5 in sedated and intubated patients.…”

Section: Institutional Treatment Principlesmentioning

confidence: 99%

Impact of smoking on course and outcome of aneurysmal subarachnoid hemorrhage

2020

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Background While the smoking-related risk of experiencing an aneurysmal subarachnoid hemorrhage (aSAH) is well established, it remains unclear whether smoking has an unexpected “protective effect” in aSAH, or if smokers are more at risk for complications and poor outcomes. Methods Prospective, observational study investigating the course and outcome of aSAH in patients admitted during the years 2011 and 2012. Smoking status at admittance, demographic, medical, and radiological variables were registered along with management, complications, and outcome at 1 year in terms of mortality, modified Rankin score, and Glasgow outcome score extended. We compared current smokers with nonsmokers on group level and by paired analysis matched by aSAH severity, age, and severity of vasospasm. Results We included 237 patients, thereof 138 current smokers (58.2%). Seventy-four smoker/nonsmoker pairs were matched. Smokers presented more often in poor clinical grade, had less subarachnoid blood, and were younger than nonsmokers. Ruptured aneurysms were larger, and multiple aneurysms more common in smokers. Severe multi-vessel vasospasm was less frequent in smokers, whereas all other complications occurred at similar rates. Mortality at 30 days was lower in smokers and functional outcome was similar in smokers and nonsmokers. Poor clinical grade, age, cerebral infarction, and vertebrobasilar aneurysms were independent predictors of 1-year mortality and of poor functional outcome. Serious comorbidity was a predictor of 1-year mortality. Smoking did not predict mortality or poor functional outcome. Conclusions Notwithstanding clinically more severe aSAH, smokers developed less frequently severe vasospasm and had better outcome than expected. The risk for complications after aSAH is not increased in smokers.

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“…Patients with aneurysmal subarachnoid hemorrhage are critical and require intensive care, and mechanical ventilation is a routine treatment in intensive care [18,19]. The assessment and risk factors for the development of DCI after surgery in patients with aSAH who require mechanical ventilation have not been studied, and there is no specific risk screening tool for this group of patients.…”

Section: Introductionmentioning

confidence: 99%

Construction and Verification of a Risk Prediction Model for the Occurrence of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage Requiring Mechanical Ventilation

Chen

Leng

et al. 2023

BioMed Research International

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Objectives. Delayed cerebral ischemia (DCI) contributes to poor aneurysm prognosis. Subarachnoid hemorrhage and DCI have irreversible and severe consequences once they occur; therefore, early prediction and prevention are important. We investigated the risk factors for postoperative complications of DCI in patients with aneurysmal subarachnoid hemorrhage (aSAH) requiring mechanical ventilation in intensive care and validated a prediction model. Methods. We retrospectively analyzed patients with aSAH who were treated in a French university hospital neuro-ICU between January 2010 and December 2015. The patients were randomized into a training group (144) and verification groups (60). Nomograms were validated in the training and verification groups, where receiver operating characteristic curve analysis was used to verify model discrimination; calibration curve and Hosmer-Lemeshow test were used to determine model calibration; and decision curve analysis (DCA) was used to verify clinical validity of the model. Results. External ventricular drain (EVD), duration of mechanical ventilation, and treatment were significantly associated in the univariate analysis; EVD and rebleeding were significantly associated with the occurrence of DCI after aSAH. Binary logistic regression was used to select five clinicopathological characteristics to predict the occurrence of DCI in patients with aSAH requiring mechanical ventilation nomograms of the risk of DCI. Area under the curve values for the training and verification groups were 0.768 and 0.246, with Brier scores of 0.166 and 0.163, respectively. Hosmer-Lemeshow calibration test values for the training and verification groups were x 2 = 3.824 ( P = 0.923 ) and x 2 = 10.868 ( P = 0.285 ), respectively. Calibration curves showed good agreement. DCA indicated that the training and verification groups showed large positive returns in the broad risk range of 0-77% and 0-63%, respectively. Conclusions. The predictive model of concurrent DCI in aSAH has theoretical and practical values and can provide individualized treatment options for patients with aSAH who require mechanical ventilation.

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The effect of tracheotomy on drug consumption in patients with acute aneurysmal subarachnoid hemorrhage: an observational study

Cited by 5 publications

References 26 publications

Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5

Survival and outcome in patients with aneurysmal subarachnoid hemorrhage in Glasgow coma score 3–5

Impact of smoking on course and outcome of aneurysmal subarachnoid hemorrhage

Construction and Verification of a Risk Prediction Model for the Occurrence of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage Requiring Mechanical Ventilation

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