Early Transcranial Doppler Evaluation of Cerebral Autoregulation Independently Predicts Functional Outcome After Aneurysmal Subarachnoid Hemorrhage.

Autor: Rynkowski CB; Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. carlarynkowski@gmail.com.; Adult Critical Care Unit, Hospital Cristo Redentor, Rua Domingos Rubbo, 20, Porto Alegre, Rio Grande do Sul, CEP: 91040-000, Brazil. carlarynkowski@gmail.com., de Oliveira Manoel AL; Critical Care Unit, Hospital Paulistano, UnitedHealth Group Brazil, São Paulo, SP, Brazil.; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Toronto, Canada., Dos Reis MM; Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil., Puppo C; Hospital de Clínicas Dr. Manuel Quintela, Universidad de la Republica, Montevideo, Uruguay., Worm PV; Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil., Zambonin D; Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Rio Grande do Sul, Brazil., Bianchin MM; Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Division of Neurology, Hospital de Clínicas de Porto Alegre - B.R.A.I.N, Porto Alegre, Rio Grande do Sul, Brazil.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2019 Oct; Vol. 31 (2), pp. 253-262.
DOI: 10.1007/s12028-019-00732-5
Abstrakt: Background: Cerebral autoregulation (CA) impairment after aneurysmal subarachnoid hemorrhage (SAH) has been associated with delayed cerebral ischemia and an unfavorable outcome. We investigated whether the early transient hyperemic response test (THRT), a transcranial Doppler (TCD)-based CA evaluation method, can predict functional outcome 6 months after aneurysmal SAH.
Methods: This is a prospective observational study of all aneurysmal SAH patients consecutively admitted to a single center between January 2016 and February 2017. CA was evaluated within 72 h of hemorrhage by THRT, which describes the changes in cerebral blood flow velocity after a brief compression of the ipsilateral common carotid artery. CA was considered to be preserved when an increase ≥ 9% of baseline systolic velocity was present. According to the modified Rankin Scale (mRS: 4-6), the primary outcome was unfavorable 6 months after hemorrhage. Secondary outcomes included cerebral infarction, vasospasm on TCD, and an unfavorable outcome at hospital discharge.
Results: Forty patients were included (mean age = 54 ± 12 years, 70% females). CA was impaired in 19 patients (47.5%) and preserved in 21 (52.5%). Impaired CA patients were older (59 ± 13 vs. 50 ± 9, p = 0.012), showed worse neurological conditions (Hunt&Hess 4 or 5-47.4% vs. 9.5%, p = 0.012), and clinical initial condition (APACHE II physiological score-12 [5.57-13] vs. 3.5 [3-5], p = 0.001). Fourteen patients in the impaired CA group and one patient in the preserved CA group progressed to an unfavorable outcome (73.7% vs. 4.7%, p = 0.0001). The impaired CA group more frequently developed cerebral infarction than the preserved CA group (36.8% vs. 0%, p = 0.003, respectively). After multivariate analysis, impaired CA (OR 5.15 95% CI 1.43-51.99, p = 0.033) and the APACHE II physiological score (OR 1.67, 95% CI 1.01-2.76, p = 0.046) were independently associated with an unfavorable outcome.
Conclusions: Early CA impairment detected by TCD and admission APACHE II physiological score independently predicted an unfavorable outcome after SAH.
Databáze: MEDLINE
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