title: Monitoring of brain tissue oxygenation following severe subarachnoid hemorrhage.
abstract: The purpose of this prospective observational study was to investigate the relation between the frequency of critical neuromonitoring parameters (brain tissue pO2, (PtiO2) < or = 10 mmHg, intracranial pressure (ICP) > 20 mmHg, cerebral perfusion pressure (CPP) < or = 70 mmHg) and outcome after severe aneurysmal subarachnoid hemorrhage (SAH). In a prospective study on 42 patients monitoring of ICP, CPP, and PtiO2 (in the area at risk for vasospasm) was performed. All patients were primarily classified as Hunt and Hess grade 4 or with secondary deterioration to this grade. Relative proportions of PtiO2 < or = 10 mmHg (n = 42), ICP > 20 mmHg (n = 25) and CPP < or = 70 mmHg (n = 23) were derived from multimodal neuromonitoring data sets for different time intervals, i.e. 1. the total monitoring time; 2. the total monitoring time without the last two monitoring days; 3. the second last monitoring day; and 4. the last monitoring day. Patients were divided into nonsurvivors (GOS = 1) and survivors (GOS = 3-5). For the total monitoring time, significant differences in the relative proportion of critical values were found for all neuromonitoring parameters (p < 0.05). The detailed analysis of consecutive time intervals revealed significantly increased proportions of critical values in nonsurvivors for all neuromonitoring parameters during the last day only. Additionally, ICP > 20 mmHg was significantly more frequent during the second last day (p < 0.01). For other time periods no differences were observed. We conclude, that critical neuromonitoring values are not early predictors of nonsurvival in patients suffering from severe SAH.
authors.affiliation: Department of Neurosurgery, University of Leipzig, Leipzig, Johannisallee 34, D-04103 Leipzig, Germany. meix@medizin.uni-leipzig.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Meixensberger
authors.forename: Albert
authors.initials: A
authors.lastname: Vath
authors.forename: Matthias
authors.initials: M
authors.lastname: Jaeger
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Kunze
authors.forename: Jim
authors.initials: J
authors.lastname: Dings
authors.forename: Klaus
authors.initials: K
authors.lastname: Roosen
mesh_terms: D000328:Adult; D001921:Brain / Q000378:metabolism*; D003422:Critical Care; D006801:Humans; D007427:Intracranial Pressure; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000401:mortality; D014057:Tomography, X-Ray Computed
chemical_list: D010100:Oxygen