Skip to main content

Advertisement

SpringerLink
Log in

Transpulmonary thermodilution monitoring–guided hemodynamic management improves cognitive function in patients with aneurysmal subarachnoid hemorrhage: a prospective cohort comparison

  • Original Article - Neurosurgical intensive care
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The effects of goal-directed hemodynamic management using transpulmonary thermodilution (TPT) monitor on the cognitive function of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain unclear. The present study aimed to determine whether hemodynamic management with TPT monitor provides better cognitive function compared with standard hemodynamic management.

Methods

Patients with aSAH who were admitted to the intensive care unit in 2016 were assigned to cohort 1, and those admitted in 2017 were assigned to cohort 2. In cohort 1, hemodynamic and fluid management was performed in accordance with the traditional pressure-based hemodynamic parameters and clinical examination, whereas in cohort 2, it was performed in accordance with the TPT monitor-measured flow-based parameters. The incidence of delayed cerebral ischemia (DCI) and pulmonary edema (PE) was determined. The functional outcome of patients was assessed using the modified Rankin scale (mRS) score and Montreal cognitive assessment (MoCA) test at 1 year following aSAH.

Results

Cohort 1 included 45 patients and cohort 2 included 39 patients who completed the trial. The incidence of DCI (38% versus 26%) and PE (11% versus 3%) was comparable between the cohorts (p > 0.05). The mRS score was similar between the cohorts (p = 0.11). However, the MoCA score was 20.2 (19.2–21.4) and 23.5 (22.2–24.8) in cohort 1 and cohort 2, respectively (p < 0.001). Accordingly, the occurrence of poor MoCA score (38% versus 18%) was significantly lower in cohort 2 (p = 0.045).

Conclusions

TPT monitor-based hemodynamic management provides better cognitive outcome than standard hemodynamic management in patients with aSAH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ali A, Bitir B, Abdullah T, Sabanci PA, Aras Y, Aydoseli A, Tanirgan G, Sencer S, Akinci IO (2018) Gray-to-white matter ratio predicts long-term recovery potential of patients with aneurysmal subarachnoid hemorrhage. Neurosurg Rev. https://doi.org/10.1007/s10143-018-1029-y

  2. Bederson JB, Connolly ES Jr, Batjer HH et al (2009) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 40:994–1025

    Article  PubMed  Google Scholar 

  3. Darkwah Oppong M, Iannaccone A, Gembruch O, Pierscianek D, Chihi M, Dammann P, Köninger A, Müller O, Forsting M, Sure U, Jabbarli R (2018) Vasospasm-related complications after subarachnoid hemorrhage: the role of patients’ age and sex. Acta Neurochir 160:1393–1400

    Article  PubMed  Google Scholar 

  4. de Rooij NK, Rinkel GJ, Dankbaar JW, Frijns CJ (2013) Delayed cerebral ischemia after subarachnoid hemorrhage: a systematic review of clinical, laboratory, and radiological predictors. Stroke. 44:43–54

    Article  CAS  PubMed  Google Scholar 

  5. Francoeur CL, Mayer SA (2016) Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 20:277

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hoff RG, van Dijk GW, Algra A, Kalkman CJ, Rinkel GJ (2008) Fluid balance and blood volume measurement after aneurysmal subarachnoid hemorrhage. Neurocrit Care 8:391–397

    Article  PubMed  Google Scholar 

  7. Kissoon NR, Mandrekar JN, Fugate JE, Lanzino G, Wijdicks EF, Rabinstein AA (2015) Positive fluid balance is associated with poor outcomes in subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 24:2245–2251

    Article  PubMed  Google Scholar 

  8. Kumar A, Anel R, Bunnell E et al (2004) Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med 32:691–699

    Article  PubMed  Google Scholar 

  9. Muroi C, Keller M, Pangalu A, Fortunati M, Yonekawa Y, Keller E (2008) Neurogenic pulmonary edema in patients with subarachnoid hemorrhage. J Neurosurg Anesthesiol 20:188–192

    Article  PubMed  Google Scholar 

  10. Mutoh T, Kazumata K, Ajiki M, Ushikoshi S, Terasaka S (2007) Goal-directed fluid management by bedside transpulmonary hemodynamic monitoring after subarachnoid hemorrhage. Stroke 38:3218–3224

    Article  PubMed  Google Scholar 

  11. Mutoh T, Kazumata K, Ishikawa T, Terasaka S (2009) Performance of bedside transpulmonary thermodilution monitoring for goal-directed hemodynamic management after subarachnoid hemorrhage. Stroke 40:2368–2374

    Article  PubMed  Google Scholar 

  12. Mutoh T, Ishikawa T, Suzuki A, Yasui N (2010) Continuous cardiac output and near-infrared spectroscopy monitoring to assist in management of symptomatic cerebral vasospasm after subarachnoid hemorrhage. Neurocrit Care 13:331–338

    Article  PubMed  Google Scholar 

  13. Mutoh T, Kazumata K, Kobayashi S, Terasaka S, Ishikawa T (2012) Serial measurement of extravascular lung water and blood volume during the course of neurogenic pulmonary edema after subarachnoid hemorrhage: initial experience with 3 cases. J Neurosurg Anesthesiol 24:203–208

    Article  PubMed  Google Scholar 

  14. Mutoh T, Kazumata K, Terasaka S, Taki Y, Suzuki A, Ishikawa T (2014) Early intensive versus minimally invasive approach to postoperative hemodynamic management after subarachnoid hemorrhage. Stroke 45:1280–1284

    Article  PubMed  Google Scholar 

  15. Mutoh T, Kazumata K, Yokoyama Y, Ishikawa T, Taki Y, Terasaka S, Houkin K (2015) Comparison of postoperative volume status and hemodynamics between surgical clipping and endovascular coiling in patients after subarachnoid hemorrhage. J Neurosurg Anesthesiol 27:7–15

    Article  PubMed  Google Scholar 

  16. Okazaki T, Kuroda Y (2018) Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome. J Intensive Care 6:28

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ozdilek B, Kenangil G (2014) Validation of the Turkish version of the Montreal Cognitive Assessment Scale (MoCA-TR) in patients with Parkinson’s disease. Clin Neuropsychol 28:333–343

    Article  PubMed  Google Scholar 

  18. Rabinstein AA (2015) Critical care of aneurysmal subarachnoid hemorrhage: state of the art. Acta Neurochir Suppl 120:239–242

    PubMed  Google Scholar 

  19. Rowland MJ, Hadjipavlou G, Kelly M, Westbrook J, Pattinson KT (2012) Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm. Br J Anaesth 109:315–329

    Article  CAS  PubMed  Google Scholar 

  20. Tagami T, Kuwamoto K, Watanabe A et al (2014) Optimal range of global end-diastolic volume for fluid management after aneurysmal subarachnoid hemorrhage: a multicenter prospective cohort study. Crit Care Med 42:1348–1356

    Article  PubMed  Google Scholar 

  21. van Gijn J, Kerr RS, Rinkel GJ (2007) Subarachnoid haemorrhage. Lancet 369:306–318

    Article  PubMed  Google Scholar 

  22. Vergouw LJM, Egal M, Bergmans B et al (2017) High early fluid input after aneurysmal subarachnoid hemorrhage: combined report of association with delayed cerebral ischemia and feasibility of cardiac output-guided fluid restriction. J Intensive Care Med 1:885066617732747

    Google Scholar 

  23. Vergouwen MD, Participants in the International Multi-Disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage (2011) Vasospasm versus delayed cerebral ischemia as an outcome event in clinical trials and observational studies. Neurocrit Care 15:308–311

    Article  PubMed  Google Scholar 

  24. Watanabe A, Tagami T, Yokobori S, Matsumoto G, Igarashi Y, Suzuki G, Onda H, Fuse A, Yokota H (2012) Global end-diastolic volume is associated with the occurrence of delayed cerebral ischemia and pulmonary edema after subarachnoid hemorrhage. Shock 38:480–485

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the Turkish Neurosurgical Society for its assistance in English editing of the study.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Turgut Ozal cad. Fatih, Istanbul, Turkey

    Achmet Ali, Taner Abdullah, Mukadder Orhan-Sungur, Gunseli Orhun, Elif Aygun, Evren Aygun & Ibrahim Ozkan Akinci

  2. Department of Neurosurgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey

    Pulat Akin Sabanci & Yavuz Aras

Authors
  1. Achmet Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taner Abdullah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mukadder Orhan-Sungur
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gunseli Orhun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elif Aygun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Evren Aygun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pulat Akin Sabanci
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yavuz Aras
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ibrahim Ozkan Akinci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Achmet Ali.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neurosurgical intensive care

Electronic supplementary material

Supplement Figure 1

Hemodynamic variables of patients were shown as mean and 95% CI. Time-course changes in mean arterial pressure (MAP) (A) and central venous pressure (CVP) (B). Two-way repeated-measures ANOVA was used, and Bonferroni correction was made for time course comparison. #: significant difference between Phase 1 value. Phase 1 is mean of measurements between 1 to 3 days after ictus, Phase 2 is mean of measurements between 4 to 7 days after ictus, Phase 3 is mean of measurements between 8 to 10 days after ictus and Phase 4 is mean of measurements between 11 to 14 days after ictus. (JPG 368 kb)

Supplement Figure 2

Hemodynamic variables of patients in Cohort 2 were shown as mean and 95% CI. Time-course changes in cardiac index (CI) (A), global end-diastolic index (GEDI) (B) and extravascular lung water index (ELWI) (C). Time-course comparison made by one-way ANOVA test with Bonferroni correction. #: significant difference with Phase 1 value, *: significant difference with Phase 1 and Phase 2 values, ¥: significant difference with Phase 1, Phase 2 and Phase 3 values. Phase 1 is mean of measurements between 1 to 3 days after ictus, Phase 2 is mean of measurements between 4 to 7 days after ictus, Phase 3 is mean of measurements between 8 to 10 days after ictus and Phase 4 is mean of measurements between 11 to 14 days after ictus. (JPG 519 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ali, A., Abdullah, T., Orhan-Sungur, M. et al. Transpulmonary thermodilution monitoring–guided hemodynamic management improves cognitive function in patients with aneurysmal subarachnoid hemorrhage: a prospective cohort comparison. Acta Neurochir 161, 1317–1324 (2019). https://doi.org/10.1007/s00701-019-03922-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-019-03922-4

Keywords

Search

Navigation