Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients. In this observational study in 1167...

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Vydáno v:Journal of critical care Ročník 72; s. 154124
Hlavní autoři: Gathier, Celine S., Zijlstra, IJsbrand A.J., Rinkel, Gabriel J.E., Groenhof, T. Katrien J., Verbaan, Dagmar, Coert, Bert A., Müller, Marcella C.A., van den Bergh, Walter M., Slooter, Arjen J.C., Eijkemans, Marinus J.C.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Elsevier Inc 01.12.2022
Elsevier Limited
Témata:
Aneurysmal subarachnoid hemorrhage
Aneurysms
Blood Pressure
Brain Ischemia - complications
Cerebral Infarction
Critical care
Delayed cerebral ischemia
Hemorrhage
Humans
Intensive care
Intensive Care Units
Ischemia
Medical imaging
Patients
Rebleeding
Stroke
Subarachnoid Hemorrhage - complications
Delayed cerebral ischemia
Intensive care
Rebleeding
Blood pressure
Aneurysmal subarachnoid hemorrhage
ISSN:0883-9441, 1557-8615, 1557-8615
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Shrnutí:Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients. In this observational study in 1167 aSAH-patients admitted to the intensive care unit (ICU), adjusted hazard ratio's (aHR) were calculated for the time-dependent association of blood pressure and rebleeding or DCI. The aHRs were presented graphically, relative to a reference mean arterial pressure (MAP) of 100 mmHg and systolic blood pressure (sBP) of 150 mmHg. A MAP below 100 mmHg in the 6, 3 and 1 h before each moment in time was associated with a decreased risk of rebleeding (e.g. within 6 h preceding rebleeding: MAP = 80 mmHg: aHR 0.30 (95% confidence interval (CI) 0.11–0.80)). A MAP below 60 mmHg in the 24 h before each moment in time was associated with an increased risk of DCI (e.g. MAP = 50 mmHg: aHR 2.59 (95% CI 1.12–5.96)). Our results suggest that a MAP below 100 mmHg is associated with decreased risk of rebleeding, and a MAP below 60 mmHg with increased risk of DCI. •In our observational study of 1167 SAH patients, MAP < 100 mmHg was associated with decreased risk of rebleeding.•MAP < 60 mmHg was associated with increased risk of delayed cerebral ischemia (DCI).•Whether optimizing MAP values will in fact prevent rebleeding or DCI could be subject of future prospective research.
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ISSN:0883-9441
1557-8615
1557-8615
DOI:10.1016/j.jcrc.2022.154124