Response of brain oxygen to therapy correlates with long-term outcome after subarachnoid hemorrhage.
BACKGROUND
Brain oxygen (PbtO2) monitoring can help guide care of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients. The relationship between PbtO2-directed therapy and long-term outcome is unclear. We hypothesized that responsiveness to PbtO2-directed interventions is associated with outcome.


METHODS
Seventy-six aSAH patients who underwent PbtO2 monitoring were included. Long-term outcome [Glasgow Outcome Score-Extended (GOS-E) and modified Rankin Scale (mRS)] was ascertained using the social security death database and structured telephone interviews. Univariate and multivariate regression were used to identify variables that correlated with outcome.


RESULTS
Data from 64 patients were analyzed (12 were lost to follow-up). There were 530 episodes of compromised PbtO2 (<20 mmHg) during a total of 7,174 h of monitor time treated with 1,052 interventions. Forty-two patients (66 %) survived to discharge. Median follow-up was 8.5 months (range 0.1-87). At most recent follow-up 35 (55 %) patients were alive, and 28 (44 %) had a favorable outcome (mRS ≤3). In multivariate ordinal regression analysis, only age and response to PbtO2-directed intervention correlated significantly with outcome. Increased age was associated with worse outcome (coeff. 0.8, 95 % CI 0.3-1.3, p = 0.003), and response to PbtO2-directed intervention was associated with improved outcome (coeff. -2.12, 95 % CI -4.0 to -0.26, p = 0.03). Patients with favorable outcomes had a 70 % mean rate of response to PbtO2-directed interventions whereas patients with poor outcomes had a 45 % response rate (p = 0.005).


CONCLUSIONS
Response to PbtO2-directed intervention is associated with improved long-term functional outcome in aSAH patients.
Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Leif-Erik
LE
Bohman
Jared M
JM
Pisapia
Matthew R
MR
Sanborn
Suzanne
S
Frangos
Elsa
E
Lin
Monisha
M
Kumar
Soojin
S
Park
W Andrew
WA
Kofke
Michael F
MF
Stiefel
Peter D
PD
LeRoux
Joshua M
JM
Levine
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000378:metabolism* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D010100:Oxygen / Q000032:analysis*; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000378:metabolism* / Q000628:therapy; D013997:Time Factors
D010100:Oxygen