| Are optimal cerebral perfusion pressure and cerebrovascular autoregulation related to long-term outcome in patients with aneurysmal subarachnoid hemorrhage? | |
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MedLine Citation:
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PMID: 21709587 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND OBJECTIVES: Continuous assessment of the cerebrovascular autoregulation (CVA) through use of the pressure reactivity index (PRx), a moving linear correlation coefficient between mean arterial blood pressure and intracranial pressure, has been effective in optimizing cerebral perfusion pressure (CPPopt) in traumatic brain injured (TBI) patients. This study investigates the feasibility of measuring CPPopt in patients with aneurysmal subarachnoid hemorrhage (aSAH) by continuously assessing the CVA. METHODS: Twenty-nine aSAH patients were enrolled, and data from CVA status, CPPopt, and periods when CPP was below, within, or above CPPopt were computed daily. Outcome was assessed at 6 months with the Glasgow Outcome Scale. Mann-Whitney U test was used to analyze differences in the duration of impaired CVA and duration of CPP below CPPopt in patients with good and poor outcomes. Multivariable logistic regression analysis was used to identify independent predictors of outcome. RESULTS: CVA monitoring data were available for all 29 patients with a total monitoring time of 2757 h. The duration of impaired CVA was 36.5% (interquartile range: 24.6 to 49.8) of the total monitoring time in 15 patients with good outcome and 71.6% of the total monitoring time (51.2 to 80.0) in 14 patients with poor outcome (Mann-Whitney U test 3.295, P=0.0010). PRx-based CPPopt could be identified in 26 patients (89.6%) with a total monitoring time of 2691 h. The duration of CPP below the CPPopt range was 28.0% (interquartile range: 18.0 to 47.0) of the total monitoring time in patients with good outcome and 76.0% (48.5 to 82.5) in patients with poor outcome (Mann-Whitney U test 2.779, P=0.0054). Glasgow Coma Scale score and duration of impaired CVA were independently associated with 6-month outcome (Glasgow Coma Scale score odds ratio: 1.95, 95% confidence interval: 1.01-3.75; duration of impaired CVA odds ratio: 0.88, 95% confidence interval: 0.78-0.99). CONCLUSIONS: The assessment of CVA and CPPopt is feasible in aSAH patients and may provide important information regarding long-term outcome. A PRx above the 0.2 threshold and a CPP below the CPPopt range are associated with worse outcome. |
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Authors:
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Frank Anthony Rasulo; Alan Girardini; Andrea Lavinio; Elena De Peri; Roberto Stefini; Marco Cenzato; Ilaria Nodari; Nicola Latronico |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of neurosurgical anesthesiology Volume: 24 ISSN: 1537-1921 ISO Abbreviation: J Neurosurg Anesthesiol Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2011-12-14 Completed Date: 2012-04-05 Revised Date: 2012-08-06 |
Medline Journal Info:
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Nlm Unique ID: 8910749 Medline TA: J Neurosurg Anesthesiol Country: United States |
Other Details:
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Languages: eng Pagination: 3-8 Citation Subset: IM |
Affiliation:
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Department of Neuroanesthesia-Neurointensive Care, University of Brescia, Spedali Civili, Brescia, Italy. rasulo@med.unibs.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Pressure / physiology* Brain Ischemia / etiology, physiopathology Cerebrovascular Circulation / physiology* Data Interpretation, Statistical Feasibility Studies Female Glasgow Coma Scale Homeostasis / physiology* Humans Intracranial Pressure / physiology Logistic Models Male Middle Aged Monitoring, Intraoperative Nervous System Diseases / etiology Neurosurgical Procedures Perfusion Postoperative Complications / physiopathology Subarachnoid Hemorrhage / physiopathology*, surgery* Tomography, X-Ray Computed Treatment Outcome Vasospasm, Intracranial / etiology, physiopathology |
| Comments/Corrections | |
Comment In:
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J Neurosurg Anesthesiol. 2012 Jan;24(1):1-2
[PMID:
22045157
]
J Neurosurg Anesthesiol. 2012 Jul;24(3):240-1 [PMID: 22441434 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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