A diagnostic flowchart, including TCD, Xe-CT and angiography, to improve the diagnosis of vasospasm critically affecting cerebral blood flow in patients with subarachnoid haemorrhage, sedated and ventilated.
The aim of this study was to prospectively evaluate a clinical protocol including transcranial doppler (TCD), Xenon-CT (Xe-CT) and angiography, for the detection of vasospasm leading to critical reductions of regional cerebral blood flow (rCBF) in both ventilated and sedated SAH patients, i.e. patients in whom clinical evaluation was not possible. Seventy-six patients were prospectively included in a surveillance protocol for daily TCD vasospasm monitoring. When TCD showed a V(mean) above 120 cm/sec in the middle cerebral artery (MCA), patients underwent Xe-CT study. If rCBF in the MCA was reduced to below 20 ml/100 g/min or if there was a reduction in the rCBF with significant asymmetry between the two MCAs, angiography was performed. Conversely, further Xe-CT and angiography were not obtained unless the TCD V(mean) values reached values above 160 cm/sec. In 35 patients, V(mean) attained values above 120 cm/sec, but only in five of them, rCBF was suggestive of vasospasm, and angiography confirmed the diagnosis in four. The protocol suggests that in sedated and ventilated patients, detection of a critical rCBF reduction due to vasospasm is possible to allow for more specific treatment and to reduce undue medical complications.
Chieregato
A
A
Unitá Operativa Anestesia e Rianimazione, Ospedale M. Bufalini, Viale Ghirotti 286, 47023 Cesena, Italy. achiere@ausl-cesena.emr.it
Battaglia
R
R
Sabia
G
G
Compagnone
C
C
Cocciolo
F
F
Tagliaferri
F
F
Pascarella
R
R
Pasquini
U
U
Frattarelli
M
M
Targa
L
L
D000792:Angiography; D001921:Brain / Q000098:blood supply; D054810:Deep Sedation; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012039:Regional Blood Flow; D012121:Respiration, Artificial; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology; D014978:Xenon
D014978:Xenon