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Neurocritical Care

, Volume 19, Issue 3, pp 320–328 | Cite as

Response of Brain Oxygen to Therapy Correlates with Long-Term Outcome After Subarachnoid Hemorrhage

  • Leif-Erik Bohman
  • Jared M. Pisapia
  • Matthew R. Sanborn
  • Suzanne Frangos
  • Elsa Lin
  • Monisha Kumar
  • Soojin Park
  • W. Andrew Kofke
  • Michael F. Stiefel
  • Peter D. LeRoux
  • Joshua M. Levine
Original Article

Abstract

Background

Brain oxygen (PbtO2) monitoring can help guide care of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients. The relationship between PbtO2-directed therapy and long-term outcome is unclear. We hypothesized that responsiveness to PbtO2-directed interventions is associated with outcome.

Methods

Seventy-six aSAH patients who underwent PbtO2 monitoring were included. Long-term outcome [Glasgow Outcome Score-Extended (GOS-E) and modified Rankin Scale (mRS)] was ascertained using the social security death database and structured telephone interviews. Univariate and multivariate regression were used to identify variables that correlated with outcome.

Results

Data from 64 patients were analyzed (12 were lost to follow-up). There were 530 episodes of compromised PbtO2 (<20 mmHg) during a total of 7,174 h of monitor time treated with 1,052 interventions. Forty-two patients (66 %) survived to discharge. Median follow-up was 8.5 months (range 0.1–87). At most recent follow-up 35 (55 %) patients were alive, and 28 (44 %) had a favorable outcome (mRS ≤3). In multivariate ordinal regression analysis, only age and response to PbtO2-directed intervention correlated significantly with outcome. Increased age was associated with worse outcome (coeff. 0.8, 95 % CI 0.3–1.3, p = 0.003), and response to PbtO2-directed intervention was associated with improved outcome (coeff. −2.12, 95 % CI −4.0 to −0.26, p = 0.03). Patients with favorable outcomes had a 70 % mean rate of response to PbtO2-directed interventions whereas patients with poor outcomes had a 45 % response rate (p = 0.005).

Conclusions

Response to PbtO2-directed intervention is associated with improved long-term functional outcome in aSAH patients.

Keywords

Brain tissue oxygen pressure Brain hypoxia Cerebral perfusion pressure Outcome Subarachnoid hemorrhage 

Notes

Acknowledgments

Supported by Research Grants from the Integra Foundation (PDL), Integra Neurosciences (PDL), and the Mary Elisabeth Groff Surgical and Medical Research Trust (PDL). PDL is a member of Integra’s Speaker’s Bureau and a Consultant for Integra LifeSciences.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Leif-Erik Bohman
    • 1
  • Jared M. Pisapia
    • 1
  • Matthew R. Sanborn
    • 1
  • Suzanne Frangos
    • 1
  • Elsa Lin
    • 2
  • Monisha Kumar
    • 1
    • 2
    • 3
  • Soojin Park
    • 1
    • 2
    • 3
  • W. Andrew Kofke
    • 1
    • 3
  • Michael F. Stiefel
    • 4
  • Peter D. LeRoux
    • 5
  • Joshua M. Levine
    • 1
    • 2
    • 3
  1. 1.Department of NeurosurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of NeurologyHospital of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Anesthesiology and Critical CareHospital of the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of NeurosurgeryNew York Medical College, Westchester Medical CenterValhallaUSA
  5. 5.Department of NeurosurgeryThomas Jefferson UniversityPhiladelphiaUSA

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