Detection of Cerebral Compromise With Multimodality Monitoring in Patients With Subarachnoid Hemorrhage

Abstract BACKGROUND: Studies in traumatic brain injury suggest that monitoring techniques such as brain tissue oxygen (Pbto2) and cerebral microdialysis may complement conventional intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurements. OBJECTIVE: In this study of poor-grade...

Celý popis

Uloženo v:

Podrobná bibliografie
Vydáno v:	Neurosurgery Ročník 69; číslo 1; s. 53 - 63
Hlavní autoři:	Chen, H Isaac, Stiefel, Michael F, Oddo, Mauro, Milby, Andrew H, Maloney-Wilensky, Eileen, Frangos, Suzanne, Levine, Joshua M, Kofke, W Andrew, LeRoux, Peter D
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Hagerstown, MD Oxford University Press 01.07.2011 Lippincott Williams & Wilkins Wolters Kluwer Health, Inc
Témata:	Adult Aged Aneurysms Biological and medical sciences Energy Metabolism - physiology Female Humans Hypoxia Hypoxia, Brain - etiology Intracranial Pressure - physiology Male Medical sciences Microdialysis Middle Aged Monitoring, Physiologic - methods Neurosurgery Oxygen - metabolism Physical Examination Pressure Retrospective Studies Sensitivity and Specificity Statistics, Nonparametric Stroke Subarachnoid Hemorrhage - complications Subarachnoid Hemorrhage - diagnosis Subarachnoid Hemorrhage - metabolism Subarachnoid Hemorrhage - mortality Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Cerebral metabolism Cerebral microdialysis Lactate/pyruvate ratio Subarachnoid hemorrhage Multimodality monitoring Brain tissue oxygen Human Oxygen Nervous system diseases Pyruvate Cardiovascular disease Medical screening Metabolism Encephalon Lactates Microdialysis Surgery Lactic acid Monitoring
ISSN:	0148-396X, 1524-4040, 1524-4040
On-line přístup:	Získat plný text
Tagy:	Přidat tag Žádné tagy, Buďte první, kdo vytvoří štítek k tomuto záznamu!

Popis
Shrnutí:	Abstract BACKGROUND: Studies in traumatic brain injury suggest that monitoring techniques such as brain tissue oxygen (Pbto2) and cerebral microdialysis may complement conventional intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurements. OBJECTIVE: In this study of poor-grade (Hunt and Hess grade IV and V) subarachnoid hemorrhage (SAH) patients, we examined the prevalence of brain hypoxia and brain energy dysfunction in the presence of normal and abnormal ICP and CPP. METHODS: SAH patients who underwent multimodal neuromonitoring and cerebral microdialysis were studied. We examined the frequency of brain hypoxia and energy dysfunction in different ICP and CPP ranges and the relationship between Pbto2 and the lactate/pyruvate ratio (LPR). RESULTS: A total of 2394 samples from 19 patients were analyzed. There were 149 samples with severe brain hypoxia (Pbto2 ≤10 mm Hg) and 347 samples with brain energy dysfunction (LPR >40). The sensitivities of abnormal ICP or CPP for elevated LPR and reduced Pbto2 were poor (21.2% at best), and the LPR or Pbto2 was abnormal in many instances when ICP or CPP was normal. Severe brain hypoxia was often associated with an LPR greater than 40 (86% of samples). In contrast, mild brain hypoxia (≤20 mm Hg) and severe brain hypoxia were observed in only 53% and 36% of samples with brain energy dysfunction, respectively. CONCLUSION: Our data demonstrate that ICP and CPP monitoring may not always detect episodes of cerebral compromise in SAH patients. Our data suggest that several complementary monitors may be needed to optimize the care of poor-grade SAH patients.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0148-396X 1524-4040 1524-4040
DOI:	10.1227/NEU.0b013e3182191451