The relationship between the time of cerebral desaturation episodes and outcome in aneurysmal subarachnoid haemorrhage: a preliminary study

Burzyńska, Małgorzata; Uryga, Agnieszka; Kasprowicz, Magdalena; Czosnyka, Marek; Dragan, Barbara; Kübler, Andrzej

doi:10.1007/s10877-019-00377-x

Cited by 8 publications

(4 citation statements)

References 38 publications

(55 reference statements)

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“…As the patient's brain tissue and cranial nerves have been damaged, it is necessary to repair the damaged nerve cells, re-establish nerve function, and promote the patient's recovery. Conventional care is now the usual clinical choice to restore consciousness, but with less than satisfactory results [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

High-Quality Nursing Combined with the Whole-Course Responsibility Nursing Intervention Reduces the Incidence of Complications in Severe Aneurysmal Subarachnoid Hemorrhage

Qian

Lin²,

Zhou

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. The aim of this study is to study the influence of whole-course responsibility nursing combined with high-quality nursing intervention on the level of life and complications of severe aneurysmal subarachnoid hemorrhage patients with postoperative coma. Methods. From December 2018 to December 2020, 90 severe aneurysmal subarachnoid hemorrhage patients with postoperative coma were selected and were divided into two groups, the experimental group and the control group, with 45 cases in each group. The control group adopted conventional nursing care, and the experimental group received whole-course responsibility nursing combined with high-quality nursing intervention. The nursing effect, degree of coma, coma recovery, and incidence of complications between all groups were compared. Results. Compared with the control group, the experimental group yielded more favorable achievement in terms of the nursing effect ( P < 0.05 ). Superior levels of the Glasgow Coma Scale (GCS) score, Coma Recovery Scale-Revised (CRS-R) score, GQOLI-74 score, and BI score of the experimental group were obtained and compared with the control group (all P < 0.05 ). The experimental group witnessed a lower complication rate, as compared to the other group ( P < 0.05 ). Conclusion. The whole-course responsibility nursing combined with high-quality nursing intervention is applied to severe aneurysmal subarachnoid hemorrhage patients with postoperative coma, which can substantially optimize the nursing efficiency, improve the degree of coma, help recover consciousness, ameliorate the mental state and the quality of life, and reduce the incidence of complications, which is worthy of clinical application.

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Section: Discussionmentioning

confidence: 99%

High-Quality Nursing Combined with the Whole-Course Responsibility Nursing Intervention Reduces the Incidence of Complications in Severe Aneurysmal Subarachnoid Hemorrhage

Qian

Lin²,

Zhou

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Additionally, patients who were previously diagnosed with stroke or brain injury with chronic changes in CT, patients admitted with a diagnosis of brain death, and patients whose biomarker levels were related to diseases other than aSAH (cancer, severe kidney or liver disease, active or chronic inflammatory diseases) were excluded. Patients were treated based on standard SAH guidelines including early diagnosis, surgical clipping or coiling, and admission to the intensive care unit [17][18][19]. The choice of surgical treatment of the aneurysm was determined following a multidisciplinary discussion including vascular neurosurgeons and an interventional neuroradiologist depending on the location, size, and morphological features of the aneurysm; the presence of a mass effect caused by the aneurysm and/or an associated haematoma; the presence of multiple aneurysms; and the patient's neurological and general medical condition.…”

Section: Study Populationmentioning

confidence: 99%

The Role of Early Serum Biomarkers and Clinical Rating Scales in the Prediction of Delayed Cerebral Ischaemia and Short-Term Outcome after Aneurysmal Subarachnoid Haemorrhage: Single Centre Experience

Burzyńska,

Uryga,

Woźniak

et al. 2023

JCM

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Considering the variety of complications that arise after aneurysmal subarachnoid haemorrhage (aSAH) and the complex pathomechanism of delayed cerebral ischaemia (DCI), the task of predicting the outcome assumes a profound complexity. Therefore, there is a need to develop early predictive and decision-making models. This study explores the effect of serum biomarkers and clinical scales on patients’ outcomes and their interrelationship with DCI and systemic complications in aSAH. This was a retrospective analysis including aSAH patients admitted to the Wroclaw University Hospital (Wrocław, Poland) from 2011 to 2020. A good outcome was defined as a modified Rankin Scale (mRS) score of 0–2. The prediction of the development of DCI and poor outcome was conducted using logistic regression as a standard model (SM) and random forest as a machine learning method (ML). A cohort of 174 aSAH patients were included in the analysis. DCI was diagnosed in 79 (45%) patients. Significant differences between patients with poor vs. good outcome were determined from their levels of albumin (31 ± 7 vs. 35 ± 5 (g/L); p < 0.001), D-dimer (3.0 ± 4.5 vs. 1.5 ± 2.8 (ng/mL); p < 0.001), procalcitonin (0.2 ± 0.4 vs. 0.1 ± 0.1 (ng/mL); p < 0.001), and glucose (169 ± 69 vs. 137 ± 48 (nmol/L); p < 0.001). SM for DCI prediction included the Apache II scale (odds ratio [OD] 1.05; 95% confidence interval [CI] 1.00–1.09) and albumin level (OD 0.88; CI 0.82–0.95). ML demonstrated that low albumin level, high Apache II scale, increased D-dimer and procalcitonin levels had the highest predictive values for DCI. The integration of clinical parameters and scales with a panel of biomarkers may effectively facilitate the stratification of aSAH patients, identifying those at high risk of secondary complications and poor outcome.

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“…Using the definition of cerebral desaturation of <50% for 30 min on either side, and poor outcomes as a mRS of 4–6, it was observed that cerebral desaturation was independently associated with poor functional outcomes at 3 months (OR 2.72, 95%CI 1.02–7.20) but not at 12 months. In a small study of 38 patients using a definition of cerebral desaturation of <60% for at least 30 min on either side, patients with an unfavorable outcome spent more time with a cerebral desaturation than those with a good outcome (5 h 43 vs. 1 h 47, p = 0.02) ( 61 ). Patients with episodes of cerebral desaturation lasting more than 2 h were at much higher risk of poor short-term outcomes than those without [OR 15.4 (95% CI: 1.1–214.2%)].…”

Section: Clinical Data—vasospasm DCI Prognosismentioning

confidence: 99%

Near Infrared Spectroscopy for Poor Grade Aneurysmal Subarachnoid Hemorrhage—A Concise Review

et al. 2022

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Delayed cerebral ischemia (DCI) disproportionately affects poor grade aneurysmal subarachnoid hemorrhage (aSAH) patients. An unreliable neurological exam and the lack of appropriate monitoring leads to unrecognized DCI, which in turn is associated with severe long-term deficits and higher mortality. Near Infrared Spectroscopy (NIRS) offers simple, continuous, real time, non-invasive cerebral monitoring. It provides regional cerebral oxygen saturation (c-rSO2), which reflects the balance between cerebral oxygen consumption and supply. Reports have demonstrated a good correlation with other cerebral oxygen and blood flow monitoring, and credible cerebrovascular reactivity indices were also derived from NIRS signals. Multiple critical c-rSO2 values have been reported in aSAH patients, based on various thresholds, duration, variation from baseline or cerebrovascular reactivity indices. Some were associated with vasospasm, some with DCI and others with clinical outcomes. However, the poor grade aSAH population has not been specifically studied and no randomized clinical trial has been published. The available literature does not support a specific NIRS-based intervention threshold to guide diagnostic or treatment in aSAH patients. We review herein the fundamental basic concepts behind NIRS technology, relationship of c-rSO2 to other brain monitoring values and their potential clinical interpretation. We follow with a critical evaluation of the use of NIRS in the aSAH population, more specifically its ability to diagnose vasospasm, to predict DCI and its association to outcome. In summary, NIRS might offer significant potential for poor grade aSAH in the future. However, current evidence does not support its use in clinical decision-making, and proper technology evaluation is required.

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The relationship between the time of cerebral desaturation episodes and outcome in aneurysmal subarachnoid haemorrhage: a preliminary study

Cited by 8 publications

References 38 publications

High-Quality Nursing Combined with the Whole-Course Responsibility Nursing Intervention Reduces the Incidence of Complications in Severe Aneurysmal Subarachnoid Hemorrhage

High-Quality Nursing Combined with the Whole-Course Responsibility Nursing Intervention Reduces the Incidence of Complications in Severe Aneurysmal Subarachnoid Hemorrhage

The Role of Early Serum Biomarkers and Clinical Rating Scales in the Prediction of Delayed Cerebral Ischaemia and Short-Term Outcome after Aneurysmal Subarachnoid Haemorrhage: Single Centre Experience

Near Infrared Spectroscopy for Poor Grade Aneurysmal Subarachnoid Hemorrhage—A Concise Review

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