Protocolized Brain Oxygen Optimization in Subarachnoid Hemorrhage.
Details
Serval ID
serval:BIB_2D151F72469A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Protocolized Brain Oxygen Optimization in Subarachnoid Hemorrhage.
Journal
Neurocritical care
ISSN
1556-0961 (Electronic)
ISSN-L
1541-6933
Publication state
Published
Issued date
10/2019
Peer-reviewed
Oui
Volume
31
Number
2
Pages
263-272
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
Brain tissue hypoxia (P <sub>bt</sub> O <sub>2</sub> < 20 mmHg) is common after subarachnoid hemorrhage (SAH) and associated with poor outcome. Recent data suggest that brain oxygen optimization is feasible and reduces the time spent with P <sub>bt</sub> O <sub>2</sub> < 20 mmHg from 45 to 16% in patients with severe traumatic brain injury. Here, we intended to quantify the brain tissue hypoxia burden despite implementation of a protocolized treatment approach in poor-grade SAH patients and to identify the simultaneous occurrence of pathologic values potentially amenable to treatment.
We present a bi-centric observational cohort study including 100 poor-grade SAH patients admitted to two tertiary care centers who underwent multimodal brain monitoring and were managed with a P <sub>bt</sub> O <sub>2</sub> -targeted protocolized approach. P <sub>bt</sub> O <sub>2</sub> optimization (≥ 20 mmHg) included a stepwise neuro-intensive care approach, aiming to prevent low cerebral perfusion pressure (CPP), and blood hemoglobin, and to keep normocapnia, normoxemia, and normothermia. Based on routine blood gas analysis, hemoglobin, PaCO <sub>2,</sub> and PaO <sub>2</sub> data were matched to 2-h averaged data of continuous CPP, P <sub>bt</sub> O <sub>2</sub> , core temperature, and to hourly cerebral microdialysis (CMD) samples over the first 11 days.
Patients had a Glasgow Coma Scale of 3 (IQR 3-4) and were 58 years old (IQR 48-66). Overall incidence of brain tissue hypoxia was 25%, which was not different between both sites despite differences in the treatment approach. During brain tissue hypoxia, episodes of CPP < 70 mmHg (27%), PaCO <sub>2</sub> < 35 mmHg (19%), PaO <sub>2</sub> < 80 mmHg (14%), Hb < 9 g/dL (11%), metabolic crisis (CMD-lactate/pyruvate ratio > 40, and CMD-glucose < 0.7 mmol/L; 7%), and temperature > 38.3 °C (4%) were common.
Our results demonstrate that brain tissue hypoxia remains common despite implementation of a P <sub>bt</sub> O <sub>2</sub> -targeted therapy in poor-grade SAH patients, suggesting room for further optimization.
We present a bi-centric observational cohort study including 100 poor-grade SAH patients admitted to two tertiary care centers who underwent multimodal brain monitoring and were managed with a P <sub>bt</sub> O <sub>2</sub> -targeted protocolized approach. P <sub>bt</sub> O <sub>2</sub> optimization (≥ 20 mmHg) included a stepwise neuro-intensive care approach, aiming to prevent low cerebral perfusion pressure (CPP), and blood hemoglobin, and to keep normocapnia, normoxemia, and normothermia. Based on routine blood gas analysis, hemoglobin, PaCO <sub>2,</sub> and PaO <sub>2</sub> data were matched to 2-h averaged data of continuous CPP, P <sub>bt</sub> O <sub>2</sub> , core temperature, and to hourly cerebral microdialysis (CMD) samples over the first 11 days.
Patients had a Glasgow Coma Scale of 3 (IQR 3-4) and were 58 years old (IQR 48-66). Overall incidence of brain tissue hypoxia was 25%, which was not different between both sites despite differences in the treatment approach. During brain tissue hypoxia, episodes of CPP < 70 mmHg (27%), PaCO <sub>2</sub> < 35 mmHg (19%), PaO <sub>2</sub> < 80 mmHg (14%), Hb < 9 g/dL (11%), metabolic crisis (CMD-lactate/pyruvate ratio > 40, and CMD-glucose < 0.7 mmol/L; 7%), and temperature > 38.3 °C (4%) were common.
Our results demonstrate that brain tissue hypoxia remains common despite implementation of a P <sub>bt</sub> O <sub>2</sub> -targeted therapy in poor-grade SAH patients, suggesting room for further optimization.
Keywords
Aneurysmal subarachnoid hemorrhage, Brain, Critical care, Neurology
Pubmed
Web of science
Open Access
Yes
Create date
15/07/2019 17:48
Last modification date
15/01/2021 8:08