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

Détails

ID Serval
serval:BIB_833A42B60463
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Hemoglobin concentration and cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage.
Périodique
Stroke
Auteur(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]
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Volume
40
Numéro
4
Pages
1275-1281
Langue
anglais
Résumé
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.
Mots-clé
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
Oui
Création de la notice
09/12/2009 13:30
Dernière modification de la notice
20/08/2019 15:43
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