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

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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.

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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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Authors and Affiliations

  1. Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Leif-Erik Bohman, Jared M. Pisapia, Matthew R. Sanborn, Suzanne Frangos, Monisha Kumar, Soojin Park, W. Andrew Kofke & Joshua M. Levine

  2. Department of Neurology, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Elsa Lin, Monisha Kumar, Soojin Park & Joshua M. Levine

  3. Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Monisha Kumar, Soojin Park, W. Andrew Kofke & Joshua M. Levine

  4. Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA

    Michael F. Stiefel

  5. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    Peter D. LeRoux

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  1. Leif-Erik Bohman
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Correspondence to Joshua M. Levine.

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Bohman, LE., Pisapia, J.M., Sanborn, M.R. et al. Response of Brain Oxygen to Therapy Correlates with Long-Term Outcome After Subarachnoid Hemorrhage. Neurocrit Care 19, 320–328 (2013). https://doi.org/10.1007/s12028-013-9890-6

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  • DOI: https://doi.org/10.1007/s12028-013-9890-6

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