NYMC Faculty Publications
Response of Brain Oxygen to Therapy Correlates With Long-Term Outcome After Subarachnoid Hemorrhage
Author Type(s)
Faculty
DOI
10.1007/s12028-013-9890-6
Journal Title
Neurocritical Care
First Page
320
Last Page
328
Document Type
Article
Publication Date
12-1-2013
Abstract
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 (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.
Recommended Citation
Bohman, L., Pisapia, J., Sanborn, M., Frangos, S., Lin, E., Kumar, M., Park, S., Kofke, W., Stiefel, M., LeRoux, P., & Levine, J. (2013). Response of Brain Oxygen to Therapy Correlates With Long-Term Outcome After Subarachnoid Hemorrhage. Neurocritical Care, 19 (3), 320-328. https://doi.org/10.1007/s12028-013-9890-6
