Document Detail


Hemoglobin concentration and cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage.
MedLine Citation:
PMID:  19265059     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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
Related Documents :
7449399 - Interaction of pulmonary and systemic hypertension. an experimental study.
12842549 - Cardiotrophin-1 is a prophylactic against the development of chronic hypoxic pulmonary ...
8708909 - Sustained pulmonary vasodilation after inhaled nitric oxide for hypoxic pulmonary hyper...
24988279 - Tuning and identification of interband transitions in monolayer and bilayer molybdenum ...
11718519 - Autonomic response to hypobaric hypoxia assessed by time-dependent frequency decomposit...
1600639 - Hypoxic attenuation of brain stem serotonin does not influence sodium-induced hypertens...
2166739 - Pharmacological regulation of the circulation of bone.
21030879 - Effective antihypertensive strategies for high-risk patients with diabetic nephropathy.
15465669 - Lactose causes heart arrhythmia in the water flea daphnia pulex.
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-03-05
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-04-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1275-81     Citation Subset:  IM    
Affiliation:
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:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
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:
0/Hemoglobins; 7782-44-7/Oxygen

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


Previous Document:  Proposed criteria for metabolic syndrome in Japanese based on prospective evidence: the Hisayama stu...
Next Document:  Pulse pressure in youth and carotid intima-media thickness in adulthood: the cardiovascular risk in ...