Neurocritical Care

, Volume 12, Issue 2, pp 234–243

Correlation of Clinical Outcome with Pressure-, Oxygen-, and Flow-Related Indices of Cerebrovascular Reactivity in Patients Following Aneurysmal SAH

  • Martin Barth
  • Johannes Woitzik
  • Christel Weiss
  • Elke Muench
  • Michael Diepers
  • Peter Schmiedek
  • Hidetoshi Kasuya
  • Peter Vajkoczy
Original Article

DOI: 10.1007/s12028-009-9287-8

Cite this article as:
Barth, M., Woitzik, J., Weiss, C. et al. Neurocrit Care (2010) 12: 234. doi:10.1007/s12028-009-9287-8
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Abstract

Background

Impaired cerebrovascular reactivity (CR) has been reported to be associated with adverse outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, CR may be determined using different paradigms and it is unclear, which measurement method most suitable reflects the clinical course or is able to predict clinical deterioration.

Methods

Twenty-one aSAH patients were included in this study. Following occlusion of the aneurysms with or without implantation of nicardipine prolonged release implants (NPRIs), mean arterial and mean intracranial pressure, regional tissue oxygenation, and regional cerebral blood flow was determined. Based on these data, pressure-, oxygen-, and flow-related autoregulatory indices (PRx, ORx, FRx) were simultaneously calculated and correlated with outcome parameters including the Glasgow outcome score (GOS) and the modified Rankin (mRankin) scale.

Results

Eight patients showed newly developed cerebral infarcts. Low values of GOS and mRankin scale highly correlated with the incidence of cerebral infarcts (GOS, P = 0.001; mRankin, P = 0.003). However, indices of CR did not differ significantly between the infarction (I) and the noninfarction group (NI) (PRx, I, 0.058 ± 0.096, NI, 0.097 ± 0.203, P = 0.538; ORx, I, 0.162 ± 0.316, NI, 0.094 ± 0.176, P = 0.690; FRx, I, 0.395 ± 0.200, NI, 0.265 ± 0.177, P = 0.119). No correlation was found between indices and clinical outcome parameters (all not significant). However, ORx and FRx correlated well (P = 0.016).

Conclusions

Due to the low number of included subjects, the obtained results are preliminary. However, they indicate that either the present technique of index-determination is not sensitive enough or that there is no strong relation between the measured indices and clinical outcome. Future verification is required of continuous against already established non-continuous monitoring techniques of CR in order to relate both to clinical outcome.

Keywords

Cerebrovascular reactivity Multimodality monitoring aSAH 

Abbreviations

CR

Cerebrovascular reactivity

aSAH

Aneurysmal subarachnoid hemorrhage

ptiO2

Tissue partial pressure of oxygen

TD-rCBF

Thermal diffusion regional cerebral blood flow

CT

Computerized tomography

MAP

Mean arterial blood pressure

ICP

Intracranial pressure

NPRIs

Nicardipine prolonged release implants

PRx

Pressure reactivity index

ORx

Oxygen reactivity index

FRx

Flow reactivity index

I

Infarction group

NI

Noninfarction group

GOS

Glasgow outcome scale

mRankin

Modified Rankin scale

SD

Standard deviation

Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Martin Barth
    • 1
  • Johannes Woitzik
    • 1
  • Christel Weiss
    • 2
  • Elke Muench
    • 3
  • Michael Diepers
    • 4
  • Peter Schmiedek
    • 1
  • Hidetoshi Kasuya
    • 5
  • Peter Vajkoczy
    • 1
  1. 1.Department of NeurosurgeryMedical Faculty Mannheim of the Karl-Ruprecht-University of Heidelberg, University Hospital MannheimMannheimGermany
  2. 2.Institute for Biomedical StatisticsMedical Faculty Mannheim of the Karl-Ruprecht-University of Heidelberg, University Hospital MannheimMannheimGermany
  3. 3.Institute for Anesthesiology and Intensive Care MedicineMedical Faculty Mannheim of the Karl-Ruprecht-University of Heidelberg, University Hospital MannheimMannheimGermany
  4. 4.Department of NeuroradiologyMedical Faculty Mannheim of the Karl-Ruprecht-University of Heidelberg, University Hospital MannheimMannheimGermany
  5. 5.Department of NeurosurgeryTokyo Women’s Medical UniversityTokyoJapan

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