PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage
Abstract The partial pressure of carbon dioxide (PaCO2) in the arterial blood is a strong vasomodulator affecting cerebral blood flow and the risk of cerebral edema and ischemia after acute brain injury. In turn, both complications are related to poor outcome in patients with aneurysmal subarachnoid...
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Nature Portfolio
2021
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oai:doaj.org-article:5f888d68fb844e5eb1aec54c8cb392052021-12-02T17:37:12ZPaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage10.1038/s41598-021-98462-22045-2322https://doaj.org/article/5f888d68fb844e5eb1aec54c8cb392052021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-98462-2https://doaj.org/toc/2045-2322Abstract The partial pressure of carbon dioxide (PaCO2) in the arterial blood is a strong vasomodulator affecting cerebral blood flow and the risk of cerebral edema and ischemia after acute brain injury. In turn, both complications are related to poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to analyze the effect of PaCO2 levels on the course and outcome of aSAH. All patients of a single institution treated for aSAH over 13.5 years were included (n = 633). Daily PaCO2 values from arterial blood gas measurements were recorded for up to 2 weeks after ictus. The study endpoints were: delayed cerebral ischemia (DCI), need for decompressive craniectomy due to increased intracranial pressure > 20 mmHg refractory to conservative treatment and poor outcome at 6-months follow-up (modified Rankin scale > 2). By correlations with the study endpoints, clinically relevant cutoffs for the 14-days mean values for the lowest and highest daily PaCO2 levels were defined by receiver operating characteristic curve analysis. Association with the study endpoints for the identifies subgroups was analyzed using multivariate analysis. The optimal range for PaCO2 values was identified between 30 and 38 mmHg. ASAH patients with poor initial condition (WFNS 4/5) were less likely to show PaCO2 values within the range of 30–38 mmHg (p < 0.001, OR = 0.44). In the multivariate analysis, PaCO2 values between 30 and 38 mmHg were associated with a lower risk for decompressive craniectomy (p = 0.042, aOR = 0.27), DCI occurrence (p = 0.035; aOR = 0.50), and poor patient outcome (p = 0.004; aOR = 0.42). The data from this study shows an independent positive association between low normal mean PaCO2 values during the acute phase of aSAH and patients’ outcome. This effect might be attributed to the reduction of intracranial hypertension and alterations in the cerebral blood flow.Marvin Darkwah OppongKarsten H. WredeDaniela MüllerAlejandro N. SantosLaurèl RauschenbachThiemo F. DingerYahya AhmadipourDaniela PierscianekMehdi ChihiYan LiCornelius DeuschlUlrich SureRamazan JabbarliNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021) |
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Medicine R Science Q |
| spellingShingle |
Medicine R Science Q Marvin Darkwah Oppong Karsten H. Wrede Daniela Müller Alejandro N. Santos Laurèl Rauschenbach Thiemo F. Dinger Yahya Ahmadipour Daniela Pierscianek Mehdi Chihi Yan Li Cornelius Deuschl Ulrich Sure Ramazan Jabbarli PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage |
| description |
Abstract The partial pressure of carbon dioxide (PaCO2) in the arterial blood is a strong vasomodulator affecting cerebral blood flow and the risk of cerebral edema and ischemia after acute brain injury. In turn, both complications are related to poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to analyze the effect of PaCO2 levels on the course and outcome of aSAH. All patients of a single institution treated for aSAH over 13.5 years were included (n = 633). Daily PaCO2 values from arterial blood gas measurements were recorded for up to 2 weeks after ictus. The study endpoints were: delayed cerebral ischemia (DCI), need for decompressive craniectomy due to increased intracranial pressure > 20 mmHg refractory to conservative treatment and poor outcome at 6-months follow-up (modified Rankin scale > 2). By correlations with the study endpoints, clinically relevant cutoffs for the 14-days mean values for the lowest and highest daily PaCO2 levels were defined by receiver operating characteristic curve analysis. Association with the study endpoints for the identifies subgroups was analyzed using multivariate analysis. The optimal range for PaCO2 values was identified between 30 and 38 mmHg. ASAH patients with poor initial condition (WFNS 4/5) were less likely to show PaCO2 values within the range of 30–38 mmHg (p < 0.001, OR = 0.44). In the multivariate analysis, PaCO2 values between 30 and 38 mmHg were associated with a lower risk for decompressive craniectomy (p = 0.042, aOR = 0.27), DCI occurrence (p = 0.035; aOR = 0.50), and poor patient outcome (p = 0.004; aOR = 0.42). The data from this study shows an independent positive association between low normal mean PaCO2 values during the acute phase of aSAH and patients’ outcome. This effect might be attributed to the reduction of intracranial hypertension and alterations in the cerebral blood flow. |
| format |
article |
| author |
Marvin Darkwah Oppong Karsten H. Wrede Daniela Müller Alejandro N. Santos Laurèl Rauschenbach Thiemo F. Dinger Yahya Ahmadipour Daniela Pierscianek Mehdi Chihi Yan Li Cornelius Deuschl Ulrich Sure Ramazan Jabbarli |
| author_facet |
Marvin Darkwah Oppong Karsten H. Wrede Daniela Müller Alejandro N. Santos Laurèl Rauschenbach Thiemo F. Dinger Yahya Ahmadipour Daniela Pierscianek Mehdi Chihi Yan Li Cornelius Deuschl Ulrich Sure Ramazan Jabbarli |
| author_sort |
Marvin Darkwah Oppong |
| title |
PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage |
| title_short |
PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage |
| title_full |
PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage |
| title_fullStr |
PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage |
| title_full_unstemmed |
PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage |
| title_sort |
paco2-management in the neuro-critical care of patients with subarachnoid hemorrhage |
| publisher |
Nature Portfolio |
| publishDate |
2021 |
| url |
https://doaj.org/article/5f888d68fb844e5eb1aec54c8cb39205 |
| work_keys_str_mv |
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