| Cerebral perfusion pressure thresholds for brain tissue hypoxia and metabolic crisis after poor-grade subarachnoid hemorrhage. | |
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MedLine Citation:
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PMID: 21441155 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2011-03-24 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 42 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-04-26 Completed Date: 2011-06-30 Revised Date: 2012-09-20 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 1351-6 Citation Subset: IM |
Affiliation:
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Neurological Intensive Care Unit, Department of Neurology, Columbia University Medical Center, and Milstein Hospital, 177 Fort Washington, 8-300, New York, NY 10032, USA. mjs2134@columbia.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Energy Metabolism / physiology Female Glucose / metabolism Humans Hypoxia, Brain / epidemiology*, physiopathology* Lactates / metabolism Logistic Models Male Middle Aged Multivariate Analysis Oxidative Stress / physiology* Perfusion Pyruvates / metabolism Retrospective Studies Risk Factors Subarachnoid Hemorrhage / metabolism*, physiopathology* |
| Grant Support | |
ID/Acronym/Agency:
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KL2 RR024157/RR/NCRR NIH HHS; KL2 RR024157-04/RR/NCRR NIH HHS; KL2 RR024157-05/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Lactates; 0/Pyruvates; 50-99-7/Glucose |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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