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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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The influence of blood pressure variability on the short-term outcome in patients suffering from subarachnoid haemorrhage

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  • K. Beseoglu - Neurochirurgische Klinik, Klinikum Heinrich-Heine-Universität Düsseldorf
  • K. Unfrau - Neurochirurgische Klinik, Klinikum Heinrich-Heine-Universität Düsseldorf
  • M. Yong - Institut für medizinische Statistik und Biometrie, Klinikum Heinrich-Heine-Universität Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik, Klinikum Heinrich-Heine-Universität Düsseldorf
  • D. Hänggi - Neurochirurgische Klinik, Klinikum Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.05-05

doi: 10.3205/09dgnc139, urn:nbn:de:0183-09dgnc1390

Published: May 20, 2009

© 2009 Beseoglu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Several recent investigations demonstrated a significant influence of blood pressure variability in the follow-up course in patients suffering from acute stroke. The present study was conducted to evaluate the variability of blood pressure, intracranial pressure and cerebral perfusion pressure on short-term outcome in patients after severe subarachnoid haemorrhage (SAH).

Methods: 105 patients suffering from severe SAH were included in the study. At time of admission Glasgow Coma Score (GCS) and grading of the World Federation of Neurological Surgeons (WFNS) were defined while the short-term outcome was assessed according to GCS and the Glasgow Outcome Score (GOS). In all patients systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), intracerebral pressure (ICP) and cerebral perfusion pressure (CPP) were continuously recorded. For each recorded parameter (SBP, DBP, MAP, ICP and CPP) the first recorded value was defined as baseline value (BAS). From all recorded values of each parameter the minimum (MIN), maximum (MAX) and average (MEAN) value was identified. For each parameter the range between minimum and maximum value was calculated (RANGE). Based on the individual parameter range (absolute values) the variability of successive values was determined as the successive variation (SV). Finally, a correlation to clinical outcome was performed and statistically analyzed.

Results: Median age was 53 years (average 54.1 years ±12,462). In 105 patients the database resulted in an average of 262.8 single readings, median 248 single readings. SBPmax, and SBPrange were significantly lower in the group with improving short-term GCS outcome than in the group with stationary or deteriorating GCS (p=0,0079 and p=0,0006). SBPmin was significantly higher in the improved GCS group (p=0,0235). For successive variation (SBPsv) we could not demonstrate a significant difference between both groups (mean SBPsv 15,7 vs. 14,7; p=0,1223) and no correlation with either GCS discharge (p=0,91) or GOS discharge (p=0,841) was detectable. CPP and ICP were both without statistically significant difference between both outcome groups.

Conclusions: Systolic blood pressure levels and range appear to be of importance in the management of patients suffering from SAH and may have influence on patient outcome.