title: High-Resolution Intracranial Pressure Burden and Outcome in Subarachnoid Hemorrhage.
abstract: OBJECTIVE
  Intracranial pressure (ICP) control is a therapeutic target in patients with aneurysmal subarachnoid hemorrhage, although only a limited number of studies assessed its course and effect on outcome. Pressure-time dose (PTDICP) is a method to quantify the burden and the time spent above a defined threshold of ICP. PTDICP or its relationship with outcome has never been evaluated in aneurysmal subarachnoid hemorrhage.
  
  
  METHODS
  Analysis of data prospectively collected from aneurysmal subarachnoid hemorrhage patients admitted to Neurointensive Care Unit. Monitored data, including intraparenchymal ICP, were digitally recorded minute-by-minute in the first 7 days. PTDICP (mm Hg h) was computed using 4 predefined thresholds (15, 20, 25, and 30 mm Hg). Outcome was assessed through Extended Glasgow Outcome Scale at hospital discharge and at 6 months.
  
  
  RESULTS
  Fifty-five patients were enrolled. Forty-two patients (76%) presented with a poor clinical grade. Overall, mortality was 17% at hospital discharge and 34% at 6 months. Half of patients required extensive therapy to control high ICP during day 1. Median ICP was 10 mm Hg (4-75), whereas median PTDICP15, PTDICP20, PTDICP25, PTDICP30 were, respectively, 13, 4, 2, and 1 mm Hg h. We observed an association between mortality at hospital discharge and higher level of PTDICP using 20, 25, and 30 mm Hg as thresholds and between exposure to a moderate-level PTDICP30 and unfavorable long-term outcome.
  
  
  CONCLUSIONS
  PTDICP may better define one of the insults that the brain suffers after aneurysmal rupture, and exposure to moderate PTDICP30 was significant prognostic factor of 6-month unfavorable outcome.
authors.affiliation: From the Department of Health Science, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy (F.M., M.P., G.C.); Neurointensive care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy (A.V., G.C.); and Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.R.).
authors.forename: Federico
authors.initials: F
authors.lastname: Magni
authors.affiliation: From the Department of Health Science, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy (F.M., M.P., G.C.); Neurointensive care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy (A.V., G.C.); and Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.R.).
authors.forename: Matteo
authors.initials: M
authors.lastname: Pozzi
authors.affiliation: From the Department of Health Science, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy (F.M., M.P., G.C.); Neurointensive care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy (A.V., G.C.); and Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.R.).
authors.forename: Matteo
authors.initials: M
authors.lastname: Rota
authors.affiliation: From the Department of Health Science, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy (F.M., M.P., G.C.); Neurointensive care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy (A.V., G.C.); and Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.R.).
authors.forename: Alessia
authors.initials: A
authors.lastname: Vargiolu
authors.affiliation: From the Department of Health Science, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy (F.M., M.P., G.C.); Neurointensive care, Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy (A.V., G.C.); and Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.R.). giuseppe.citerio@unimib.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000503:physiopathology*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome
keywords: Glasgow Outcome Scale; intracranial aneurysm; intracranial pressure; subarachnoid hemorrhage