| Hemoglobin concentration and cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage. | |
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MedLine Citation:
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PMID: 19265059 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: The optimal hemoglobin (Hgb) target after aneurysmal subarachnoid hemorrhage is not precisely known. We sought to examine the threshold of Hgb concentration associated with an increased risk of cerebral metabolic dysfunction in patients with poor-grade subarachnoid hemorrhage. METHODS: Twenty consecutive patients with poor-grade subarachnoid hemorrhage who underwent multimodality neuromonitoring (intracranial pressure, brain tissue oxygen tension, cerebral microdialysis) were studied prospectively. Brain tissue oxygen tension and extracellular lactate/pyruvate ratio were used as markers of cerebral metabolic dysfunction and the relationship between Hgb concentrations and the incidence of brain hypoxia (defined by a brain tissue oxygen tension <20 mm Hg) and cell energy dysfunction (defined by a lactate/pyruvate ratio >40) was analyzed. RESULTS: Compared with higher Hgb concentrations, a Hgb concentration <9 g/dL was associated with lower brain tissue oxygen tension (27.2 [interquartile range, 21.2 to 33.1] versus 19.9 [interquartile range, 7.1 to 33.1] mm Hg, P=0.02), higher lactate/pyruvate ratio (29 [interquartile range, 25 to 38] versus 36 [interquartile range, 26 to 59], P=0.16), and an increased incidence of brain hypoxia (21% versus 52%, P<0.01) and cell energy dysfunction (23% versus 43%, P=0.03). On multivariable analysis, a Hgb concentration <9 g/dL was associated with a higher risk of brain hypoxia (OR, 7.92; 95% CI, 2.32 to 27.09; P<0.01) and cell energy dysfunction (OR, 4.24; 95% CI, 1.33 to 13.55; P=0.02) after adjusting for cerebral perfusion pressure, central venous pressure, PaO(2)/FIO(2) ratio, and symptomatic vasospasm. CONCLUSIONS: A Hgb concentration <9 g/dL is associated with an increased incidence of brain hypoxia and cell energy dysfunction in patients with poor-grade subarachnoid hemorrhage. |
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Authors:
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Mauro Oddo; Andrew Milby; Isaac Chen; Suzanne Frangos; Eileen MacMurtrie; Eileen Maloney-Wilensky; Michael Stiefel; W Andrew Kofke; Joshua M Levine; Peter D Le Roux |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-03-05 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 40 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-03-31 Completed Date: 2009-04-24 Revised Date: - |
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: 1275-81 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Clinical Research Division, University of Pennsylvania Medical Center, 3rd Floor Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104-4283. Peter.LeRoux@uphs.upenn.edu. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Brain / metabolism* Energy Metabolism / physiology* Female Hemoglobins* Humans Hypoxia, Brain / epidemiology, metabolism* Incidence Male Microdialysis Middle Aged Oxygen / blood Prospective Studies Risk Factors Subarachnoid Hemorrhage / epidemiology, metabolism* |
| Chemical | |
Reg. No./Substance:
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0/Hemoglobins; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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