Article
Interaction of induced hypertension with optimal cerebral perfusion pressure and impact on delayed cerebral infarction and outcome after aneurysmal subarachnoid haemorrhage
Der Zusammenhang zwischen induzierter Hypertension und dem optimalen zerebralen Perfusionsdruck und dessen Einfluss auf zerebrale Infarkte und das Outcome nach aneurysmatischer Subarachnoidalblutung
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Authors
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Beate Kranawetter
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Tuzi Sheri
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Onnen Mörer
- Universitätsmedizin Göttingen, Anästhesiologie, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Vesna Malinova
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: The preservation of cerebral perfusion is one of the main goals during the acute management of patients with aneurysmal subarachnoid hemorrhage (aSAH) with the aim of preventing delayed cerebral infarctions (DCI). The calculation of additional parameters such as the pressure reactivity index (PRx) has been demonstrated to be useful for defining the optimal cerebral perfusion pressure (CPPopt), which was associated with better outcome after traumatic brain injury. The role of CPPopt in aSAH-patients, especially, in those with induced hypertension (IHT), has not been determined yet. The aim of this study was to investigate the interaction of IHT with CPPopt and its impact on the incidence of DCI and on functional outcome after aSAH.
Methods: A retrospective analysis of a consecutive cohort of aSAH-patients with invasive intracranial pressure (ICP) monitoring from 2012 to 2020 was performed. PRx was calculated as the correlation coefficient of ICP and mean arterial pressure (MAP), whereas the CPPopt was the CPP-value at the lowest PRx-value. The incidence of DCI was documented. Functional outcome was assessed according to modified Rankin scale (mRS) at 3-month-follow up. The deviation of the actual CPP from CPPopt during the first two weeks after ictus was calculated and correlated with IHT, DCI-incidence and mRS at 3-months-follow up.
Results: ICP-monitoring was performed in 28% (93/324) of all patients. The mean age was 54.2 years. A higher WFNS-grade (4-5) had 64.5% (37/93) of the included patients. IHT was performed in 62.4% (58/93) with an average start on day 6 and a mean duration of 4.5 days. The CPPopt was significantly higher during IHT (p<0.0001). DCI occurred in 28% (26/93) of the patients. A larger deviation of actual CPP from CPPopt before the start of IHT was associated with higher DCI-incidence (r=0.44, p=0.02). There was a trend for a higher DCI-incidence with lower CPPopt during IHT (r=-0.24, p=0.06). A larger deviation of actual CPP from CPPopt during IHT was associated with higher mRS (worse outcome), r=0.32, p=0.02.
Conclusion: IHT had a significant influence on the CPPopt in our cohort. A larger deviation of actual CPP from optimal CPP was associated with a higher DCI-incidence and with worse outcome, compared to the patients with CPP near to the estimated CPPopt. According to our results, the estimation of CPPopt seems to be useful for guidance of IHT and preservation of optimal cerebral perfusion during the acute management of aSAH patients.
