Hemoglobin concentration and cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage.

Details

Serval ID
serval:BIB_833A42B60463
Type
Article: article from journal or magazin.
Collection
Publications
Title
Hemoglobin concentration and cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage.
Journal
Stroke
Author(s)
Oddo M., Milby A., Chen I., Frangos S., MacMurtrie E., Maloney-Wilensky E., Stiefel M., Kofke W.A., Levine J.M., Le Roux P.D.
ISSN
1524-4628[electronic]
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
40
Number
4
Pages
1275-1281
Language
english
Abstract
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.
Keywords
Adult, Aged, Brain/metabolism, Energy Metabolism/physiology, Female, Hemoglobins, Humans, Hypoxia, Brain/epidemiology, Hypoxia, Brain/metabolism, Incidence, Male, Microdialysis, Middle Aged, Oxygen/blood, Prospective Studies, Risk Factors, Subarachnoid Hemorrhage/epidemiology, Subarachnoid Hemorrhage/metabolism
Pubmed
Web of science
Open Access
Yes
Create date
09/12/2009 13:30
Last modification date
08/05/2019 21:15
Usage data