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Neurocritical Care

, Volume 23, Issue 3, pp 330–338 | Cite as

The Association Between Spontaneous Hyperventilation, Delayed Cerebral Ischemia, and Poor Neurological Outcome in Patients with Subarachnoid Hemorrhage

  • Craig A. WilliamsonEmail author
  • Kyle M. Sheehan
  • Renuka Tipirneni
  • Christopher D. Roark
  • Aditya S. Pandey
  • B. Gregory Thompson
  • Venkatakrishna Rajajee
Original Article

Abstract

Background

The frequency and associations of spontaneous hyperventilation in subarachnoid hemorrhage (SAH) are unknown. Because hyperventilation decreases cerebral blood flow, it may exacerbate delayed cerebral ischemia (DCI) and worsen neurological outcome.

Methods

This is a retrospective analysis of data from a prospectively collected cohort of SAH patients at an academic medical center. Spontaneous hyperventilation was defined by PaCO2 <35 mmHg and pH >7.45 and subdivided into moderate and severe groups. Clinical and demographic characteristics of patients with and without spontaneous hyperventilation were compared using χ 2 or t tests. Bivariate and multivariable logistic regression analyses were conducted to examine the association of moderate and severe hyperventilation with DCI and discharge neurological outcome.

Results

Of 207 patients, 113 (55 %) had spontaneous hyperventilation. Spontaneously hyperventilating patients had greater illness severity as measured by the Hunt–Hess, World Federation of Neurosurgical Societies (WFNS), and SAH sum scores. They were also more likely to develop the following complications: pneumonia, neurogenic myocardial injury, systemic inflammatory response syndrome (SIRS), radiographic vasospasm, DCI, and poor neurological outcome. In a multivariable logistic regression model including age, gender, WFNS, SAH sum score, pneumonia, neurogenic myocardial injury, etiology, and SIRS, only moderate [odds ratio (OR) 2.49, 95 % confidence interval (CI) 1.10–5.62] and severe (OR 3.12, 95 % CI 1.30–7.49) spontaneous hyperventilation were associated with DCI. Severe spontaneous hyperventilation (OR 4.52, 95 % CI 1.37–14.89) was also significantly associated with poor discharge outcome in multivariable logistic regression analysis.

Conclusion

Spontaneous hyperventilation is common in SAH and is associated with DCI and poor neurological outcome.

Keywords

Stroke Subarachnoid hemorrhage Cerebral vasospasm Hyperventilation Respiratory alkalosis Hypocapnia Brain ischemia 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Funding support

None.

Supplementary material

12028_2015_138_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Craig A. Williamson
    • 1
    • 2
    Email author
  • Kyle M. Sheehan
    • 1
    • 2
  • Renuka Tipirneni
    • 3
    • 4
  • Christopher D. Roark
    • 1
  • Aditya S. Pandey
    • 1
  • B. Gregory Thompson
    • 1
  • Venkatakrishna Rajajee
    • 1
    • 2
  1. 1.Department of NeurosurgeryUniversity of MichiganAnn ArborUSA
  2. 2.Department of NeurologyUniversity of MichiganAnn ArborUSA
  3. 3.Robert Wood Johnson Foundation Clinical Scholars ProgramUniversity of MichiganAnn ArborUSA
  4. 4.Division of General Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborUSA

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