title: Neurointensive care is justified in elderly patients with severe subarachnoid hemorrhage--an outcome and secondary insults study.
abstract: OBJECTIVE
  The aim was to study the outcome and the occurrence of secondary brain insults in elderly patients with severe subarachnoid hemorrhage (SAH) in comparison to younger patients.
  
  
  METHODS
  Ninety-nine patients with severe SAH requiring a ventriculostomy and management at the neurointensive care unit with at least 120 h of multimodality monitoring data during the first 240 h following SAH were included. Data were continuously recorded for intracranial pressure (ICP), cerebral perfusion pressure, blood pressure, oxygen saturation, and temperature. Secondary insult levels were defined and quantified as percent of good monitoring time at insult level. Outcome according to the Glasgow Outcome Scale was evaluated at 6 months after the SAH. Age-dependent differences in occurrence of secondary insults and clinical characteristics were analyzed with multiple regression analysis.
  
  
  RESULTS
  Good recovery or moderate disability was achieved in 24.1% of the elderly and in 42.9% of the younger patients. The frequency of severe disability was 41.4% in the elderly and 37.1% in the younger patients. The occurrence of ICP insults was lower and the occurrence of hypertensive, hypotensive, and hypoxemic insults were higher in the elderly patients.
  
  
  CONCLUSIONS
  An independent outcome was achieved in a substantial proportion of the elderly with severe SAH, and the proportion of severe disability was not greater than among the younger patients, which justifies neurointensive care also in elderly patients. The occurrence of secondary insults was age dependent. Future studies of multimodality monitoring may provide age-specific secondary insult levels necessary for a tailored neurointensive care specific for elderly patients with severe SAH.
authors.affiliation: Section of Neurosurgery, Department of Neuroscience, Uppsala University Hospital, 751 85 Uppsala, Sweden. Mats.Ryttlefors@Neuro.uu.se
authors.forename: Mats
authors.initials: M
authors.lastname: Ryttlefors
authors.forename: Tim
authors.initials: T
authors.lastname: Howells
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ronne-Engström
authors.forename: Pelle
authors.initials: P
authors.lastname: Nilsson
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001831:Body Temperature / Q000502:physiology; D002545:Brain Ischemia / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D019586:Intracranial Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods; D010101:Oxygen Consumption; D018458:Persistent Vegetative State / Q000453:epidemiology; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*