• J Michael Schmidt, Sang-Bae Ko, Raimund Helbok, Pedro Kurtz, R Morgan Stuart, Mary Presciutti, Luis Fernandez, Kiwon Lee, Neeraj Badjatia, E Sander Connolly, Jan Claassen, and Stephan A Mayer.
• Neurological Intensive Care Unit, Department of Neurology, Columbia University Medical Center, and Milstein Hospital, 177 Fort Washington, 8-300, New York, NY 10032, USA. mjs2134@columbia.edu
• Stroke. 2011 May 1;42(5):1351-6.

Background And PurposeTo identify a minimally acceptable cerebral perfusion pressure threshold above which the risks of brain tissue hypoxia (BTH) and oxidative metabolic crisis are reduced for patients with subarachnoid hemorrhage (SAH).MethodsWe studied 30 poor-grade SAH patients who underwent brain multimodality monitoring (3042 hours). Physiological measures were averaged over 60 minutes for each collected microdialysis sample. Metabolic crisis was defined as a lactate/pyruvate ratio>40 with a brain glucose concentration≤0.7 mmol/L. BTH was defined as PbtO2<20 mm Hg. Outcome was assessed at 3 months with the Modified Rankin Scale.ResultsMultivariable analyses adjusting for admission Hunt-Hess grade, intraventricular hemorrhage, systemic glucose, and end-tidal CO2 revealed that cerebral perfusion pressure≤70 mm Hg was significantly associated with an increased risk of BTH (OR, 2.0; 95% CI, 1.2-3.3; P=0.007) and metabolic crisis (OR, 2.1; 95% CI, 1.2-3.7; P=0.007). Death or severe disability at 3 months was significantly associated with metabolic crisis (OR, 5.4; 95% CI, 1.8-16; P=0.002) and BTH (OR, 5.1; 95% CI, 1.2-23; P=0.03) after adjusting for admission Hunt-Hess grade.ConclusionsMetabolic crisis and BTH are associated with mortality and poor functional recovery after SAH. Cerebral perfusion pressure levels<70 mm Hg was associated with metabolic crisis and BTH, and may increase the risk of secondary brain injury in poor-grade SAH patients.

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