Transpulmonary thermodilution monitoring–guided hemodynamic management improves cognitive function in patients with aneurysmal subarachnoid hemorrhage: a prospective cohort comparison

Ali, Achmet; Abdullah, Taner; Orhan-Sungur, Mukadder; Orhun, Günseli; Aygün, Elif Ganime; Aygun, Evren; Sabancı, Pulat Akın; Aras, Yavuz; Akıncı, İbrahim Özkan

doi:10.1007/s00701-019-03922-4

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…This factor may bias against TBI as a common etiology. Indeed, according to the Centers for Disease Control and Prevention, there were approximately 288,000 TBI-related hospitalizations in 2014 in the United States [31], compared to approximately 40,000-67,000 ICHs per year [32]. Similarly, spontaneous subarachnoid hemorrhage was ranked third cumulatively as a cause of coma, despite having an incidence worldwide of 6.1 per 100,000 patient-years, which is equivalent to ~ 20,000 new cases per year in the United States [33].…”

Section: Discussionmentioning

confidence: 99%

The Curing Coma Campaign International Survey on Coma Epidemiology, Evaluation, and Therapy (COME TOGETHER)

et al. 2022

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Background Although coma is commonly encountered in critical care, worldwide variability exists in diagnosis and management practices. We aimed to assess variability in coma definitions, etiologies, treatment strategies, and attitudes toward prognosis. Methods As part of the Neurocritical Care Society Curing Coma Campaign, between September 2020 and January 2021, we conducted an anonymous, international, cross-sectional global survey of health care professionals caring for patients with coma and disorders of consciousness in the acute, subacute, or chronic setting. Survey responses were solicited by sequential emails distributed by international neuroscience societies and social media. Fleiss κ values were calculated to assess agreement among respondents. Results The survey was completed by 258 health care professionals from 41 countries. Respondents predominantly were physicians (n = 213, 83%), were from the United States (n = 141, 55%), and represented academic centers (n = 231, 90%). Among eight predefined items, respondents identified the following cardinal features, in various combinations, that must be present to define coma: absence of wakefulness (81%, κ = 0.764); Glasgow Coma Score (GCS) ≤ 8 (64%, κ = 0.588); failure to respond purposefully to visual, verbal, or tactile stimuli (60%, κ = 0.552); and inability to follow commands (58%, κ = 0.529). Reported etiologies of coma encountered included medically induced coma (24%), traumatic brain injury (24%), intracerebral hemorrhage (21%), and cardiac arrest/hypoxic-ischemic encephalopathy (11%). The most common clinical assessment tools used for coma included the GCS (94%) and neurological examination (78%). Sixty-six percent of respondents routinely performed sedation interruption, in the absence of contraindications, for clinical coma assessments in the intensive care unit. Advanced neurological assessment techniques in comatose patients included quantitative electroencephalography (EEG)/connectivity analysis (16%), functional magnetic resonance imaging (7%), single-photon emission computerized tomography (6%), positron emission tomography (4%), invasive EEG (4%), and cerebral microdialysis (4%). The most commonly used neurostimulants included amantadine (51%), modafinil (37%), and methylphenidate (28%). The leading determinants for prognostication included etiology of coma, neurological examination findings, and neuroimaging. Fewer than 20% of respondents reported routine follow-up of coma survivors after hospital discharge; however, 86% indicated interest in future research initiatives that include postdischarge outcomes at six (85%) and 12 months (65%). Conclusions There is wide heterogeneity among health care professionals regarding the clinical definition of coma and limited routine use of advanced coma assessment techniques in acute care settings. Coma management practices vary across sites, and mechanisms for coordinated and sustained follow-up after acute treatment are inconsistent. There is an urgent need for the development of evidence-based guidelines and a collaborative, coordinated approach to advance both the science and the practice of coma management globally.

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Section: Discussionmentioning

confidence: 99%

The Curing Coma Campaign International Survey on Coma Epidemiology, Evaluation, and Therapy (COME TOGETHER)

et al. 2022

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“…A recent cohort study of 84 patients found that GDT using a thermodilution technique during the first 14 days after aSAH in the intensive care setting was associated with improved cognitive outcomes. 17 Another cohort study of 102 patients found that daily blood volume measurement in the intensive care unit using Pulse Dye Densitometry during the first 10 days after aSAH reduced the incidence of severe hypovolemia. 18 There is only 1 randomized controlled study assessing the outcome benefit of GDT on neurological outcome in aSAH patients.…”

Section: Discussionmentioning

confidence: 99%

“…Early experience with the use of GDT in aSAH patients in other settings has been promising. A recent cohort study of 84 patients found that GDT using a thermodilution technique during the first 14 days after aSAH in the intensive care setting was associated with improved cognitive outcomes 17. Another cohort study of 102 patients found that daily blood volume measurement in the intensive care unit using Pulse Dye Densitometry during the first 10 days after aSAH reduced the incidence of severe hypovolemia 18…”

Section: Discussionmentioning

confidence: 99%

Early Goal-directed Therapy During Endovascular Coiling Procedures Following Aneurysmal Subarachnoid Hemorrhage: A Pilot Prospective Randomized Controlled Study

Chui

Craen

Dy-Valdez

et al. 2020

Journal of Neurosurgical Anesthesiology

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Background: Maintenance of euvolemia and cerebral perfusion are recommended for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). We conducted a pilot randomized controlled study to assess the feasibility and efficacy of goal-directed therapy (GDT) to correct fluid and hemodynamic derangements during endovascular coiling in patients with aSAH.Methods: This study was conducted between November 2015 and February 2019 at a single tertiary center in Canada. Adult patients with aSAH within 5 days of aneurysm rupture were randomly assigned to receive either GDT or standard therapy during endovascular coiling. The incidence of dehydration at presentation and the efficacy of GDT were evaluated.Results: Forty patients were allocated to receive GDT (n = 21) or standard therapy (n = 19). Sixty percent of all patients were found to have dehydration before the coiling procedure commenced. Compared with standard therapy, GDT reduced the duration of intraoperative hypovolemia (mean difference 37.6 [95% confidence interval, 6.2-37.4] min, P = 0.006) and low cardiac index (mean difference 30.7 [95% confidence interval, 9.5-56.9] min, P = 0.035). There were no differences between the 2 treatment groups with respect to the incidence of vasospasm, stroke, death, and other complications up to postoperative day 90.Conclusions: A high proportion of aSAH patients presented at the coiling procedure with dehydration and a low cardiac output state; these derangements were more likely to be corrected if the GDT algorithm was used. Compared with standard therapy, use of the GDT algorithm resulted in earlier recognition and more consistent treatment of dehydration and hemodynamic derangement during endovascular coiling.

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Fluid Management in Aneurysmal Subarachnoid Hemorrhage

Mahajan

Kapoor

Prabhakar

2022

Transfusion Practice in Clinical Neurosciences

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Transpulmonary thermodilution monitoring–guided hemodynamic management improves cognitive function in patients with aneurysmal subarachnoid hemorrhage: a prospective cohort comparison

Cited by 6 publications

References 23 publications

The Curing Coma Campaign International Survey on Coma Epidemiology, Evaluation, and Therapy (COME TOGETHER)

The Curing Coma Campaign International Survey on Coma Epidemiology, Evaluation, and Therapy (COME TOGETHER)

Early Goal-directed Therapy During Endovascular Coiling Procedures Following Aneurysmal Subarachnoid Hemorrhage: A Pilot Prospective Randomized Controlled Study

Fluid Management in Aneurysmal Subarachnoid Hemorrhage

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