Articles: subarachnoid-hemorrhage.
-
Observational Study
Transcranial Doppler Arterial Pressure Gradient Is Associated With Delayed Infarction After Subarachnoid Hemorrhage.
While the pulsatility index (PI) measured by transcranial Doppler (TCD) has broader associations with outcomes in neurocritical care, its use in monitoring delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH) is not endorsed by current clinical guidelines. Recognizing that arterial pressure gradient (ΔP) can be estimated using PI, we investigated the potential significance of TCD-estimated ΔP. ⋯ Increased ΔP, rather than elevated mCBFV, was associated with DCI. While elevated mCBFV was associated with vasospasm, it was not associated with DCI. Hence, TCD-estimated ΔP may serve as a predictor for the DCI in SAH patients, a condition that impacts long-term outcome.
-
Journal of neurotrauma · Dec 2024
Vasomotion and Cerebral Blood Flow in Patients With Traumatic Brain Injury and Subarachnoid Hemorrhage: Cerebrovascular Autoregulation Versus Autonomic Control.
This study compared the roles of extraparenchymal autonomic nervous system (ANS) control of cerebral blood flow (CBF) versus intraparenchymal cerebrovascular autoregulation in 487 patients with aneurysmal subarachnoid hemorrhage (SAH) and 413 patients with traumatic brain injury (TBI). Vasomotion intensity of extraparenchymal and intraparenchymal vessels were quantified as the amplitude of oscillations of arterial blood pressure (ABP) and intracranial pressure (ICP) in the very low frequency range of 0.02-0.07 Hz, or periods of 55-15 sec, computed with a bandpass filter. A version of the pressure reactivity index (PRx-55-15) was computed as the correlation of the filtered waveforms, ABP-55-15 and ICP-55-15. ⋯ CBF in patients with TBI is more reliant on cerebrovascular autoregulation based on metabolic demand. This appears to be deficient following SAH, making the heightened ANS support necessary. Although this support is beneficial, it does not fully compensate for the loss of cerebrovascular autoregulation, as reflected in the problems in the SAH cohort with delayed cerebral ischemia and poor outcome.
-
Intrathecal nicardipine (ITN) is an investigational therapy for cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). The objective of this scoping review was to characterize the current state of the literature and map the current available evidence, examine research methodology, clarify key concepts and definitions in the literature, report procedural characteristics, identify and analyze knowledge gaps, and serve as a precursor for future systematic reviews, meta-analyses, and randomized controlled trials. An electronic search for studies on ITN for the treatment of CVS and DCI in patients with aSAH was conducted in accordance with published standards. ⋯ Study designs, drug administration, dosing regimens, drug concentrations, pharmacokinetics, patient selection, duration of therapy, outcome measures, adverse event monitoring, and definitions of CVS and DCI used are synthesized and discussed. Despite advances in the care of patients with aSAH, CVS and DCI remain leading causes of morbidity and mortality, and ITN represents a potential therapy to help prevent and treat this disease process. With one published randomized controlled trial on one method of administration, one trial underway on a second method of administration, and numerous heterogeneous and primarily retrospective studies published to date, future study with an emphasis on homogenizing study design and outcomes measured is needed to better understand this potential therapy.
-
Subarachnoid hemorrhage (SAH) is a severe neurologic event with high mortality. The choice of sedatives in SAH management may influence patient outcomes. This study aimed to investigate the association between sedatives and in-hospital mortality among patients with SAH. ⋯ Dexmedetomidine is associated with significantly lower in-hospital mortality in patients with SAH. These findings underscore the importance of sedative choice for patients with SAH, suggesting that dexmedetomidine could enhance patient outcomes.