Document Detail

Cerebral perfusion pressure thresholds for brain tissue hypoxia and metabolic crisis after poor-grade subarachnoid hemorrhage.
MedLine Citation:
PMID:  21441155     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: To identify a minimally acceptable cerebral perfusion pressure threshold above which the risks of brain tissue hypoxia (BTH) and oxidative metabolic crisis are reduced for patients with subarachnoid hemorrhage (SAH).
METHODS: We studied 30 poor-grade SAH patients who underwent brain multimodality monitoring (3042 hours). Physiological measures were averaged over 60 minutes for each collected microdialysis sample. Metabolic crisis was defined as a lactate/pyruvate ratio>40 with a brain glucose concentration≤0.7 mmol/L. BTH was defined as PbtO2<20 mm Hg. Outcome was assessed at 3 months with the Modified Rankin Scale.
RESULTS: Multivariable analyses adjusting for admission Hunt-Hess grade, intraventricular hemorrhage, systemic glucose, and end-tidal CO2 revealed that cerebral perfusion pressure≤70 mm Hg was significantly associated with an increased risk of BTH (OR, 2.0; 95% CI, 1.2-3.3; P=0.007) and metabolic crisis (OR, 2.1; 95% CI, 1.2-3.7; P=0.007). Death or severe disability at 3 months was significantly associated with metabolic crisis (OR, 5.4; 95% CI, 1.8-16; P=0.002) and BTH (OR, 5.1; 95% CI, 1.2-23; P=0.03) after adjusting for admission Hunt-Hess grade.
CONCLUSIONS: Metabolic crisis and BTH are associated with mortality and poor functional recovery after SAH. Cerebral perfusion pressure levels<70 mm Hg was associated with metabolic crisis and BTH, and may increase the risk of secondary brain injury in poor-grade SAH patients.
J Michael Schmidt; Sang-Bae Ko; Raimund Helbok; Pedro Kurtz; R Morgan Stuart; Mary Presciutti; Luis Fernandez; Kiwon Lee; Neeraj Badjatia; E Sander Connolly; Jan Claassen; Stephan A Mayer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-03-24
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  42     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-26     Completed Date:  2011-06-30     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1351-6     Citation Subset:  IM    
Neurological Intensive Care Unit, Department of Neurology, Columbia University Medical Center, and Milstein Hospital, 177 Fort Washington, 8-300, New York, NY 10032, USA.
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MeSH Terms
Energy Metabolism / physiology
Glucose / metabolism
Hypoxia, Brain / epidemiology*,  physiopathology*
Lactates / metabolism
Logistic Models
Middle Aged
Multivariate Analysis
Oxidative Stress / physiology*
Pyruvates / metabolism
Retrospective Studies
Risk Factors
Subarachnoid Hemorrhage / metabolism*,  physiopathology*
Grant Support
Reg. No./Substance:
0/Lactates; 0/Pyruvates; 50-99-7/Glucose

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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