Tags

Type your tag names separated by a space and hit enter

Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT.
J Neurosurg Anesthesiol. 2018 Jan; 30(1):49-58.JN

Abstract

BACKGROUND

The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome.

MATERIALS AND METHODS

Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3.

RESULTS

Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBF<20 mL/100 g/min was detected in more than 10% of the region-of-interest (ROI) area and in 17 patients such low-flow area exceeded 30%. rCBF was not related to the localization of the aneurysm; there was no difference in rCBF of ipsilateral compared with contralateral vascular territories. In patients who initially were in Hunt & Hess grade I to III, median global CBF day 0 to 3 was significantly lower for patients who were in poor neurological state at discharge compared with patients in good neurological state, 25.5 mL/100 g/min (IQR, 21.3 to 28.3) versus 37.8 mL/100 g/min (IQR, 30.5 to 47.6).

CONCLUSIONS

CBF disturbances are common in the early phase after SAH. In many patients, CBF was heterogenic and substantial areas with low rCBF were detected. Age and CT Fisher grade were factors influencing global cortical CBF. Bedside XeCT may be a tool to identify patients at risk of deteriorating so they can receive intensified management, but this needs further exploration.

Authors+Show Affiliations

Departments of Neuroscience/Neurosurgery. Surgical Sciences/Anesthesia and Intensive care.Departments of Neuroscience/Neurosurgery.Departments of Neuroscience/Neurosurgery.Departments of Neuroscience/Neurosurgery. Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.Departments of Neuroscience/Neurosurgery.Departments of Neuroscience/Neurosurgery.Departments of Neuroscience/Neurosurgery.Departments of Neuroscience/Neurosurgery.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27906765

Citation

Engquist, Henrik, et al. "Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied By Bedside Xenon-enhanced CT." Journal of Neurosurgical Anesthesiology, vol. 30, no. 1, 2018, pp. 49-58.
Engquist H, Lewén A, Howells T, et al. Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT. J Neurosurg Anesthesiol. 2018;30(1):49-58.
Engquist, H., Lewén, A., Howells, T., Johnson, U., Ronne-Engström, E., Nilsson, P., Enblad, P., & Rostami, E. (2018). Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT. Journal of Neurosurgical Anesthesiology, 30(1), 49-58. https://doi.org/10.1097/ANA.0000000000000395
Engquist H, et al. Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied By Bedside Xenon-enhanced CT. J Neurosurg Anesthesiol. 2018;30(1):49-58. PubMed PMID: 27906765.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT. AU - Engquist,Henrik, AU - Lewén,Anders, AU - Howells,Tim, AU - Johnson,Ulf, AU - Ronne-Engström,Elisabeth, AU - Nilsson,Pelle, AU - Enblad,Per, AU - Rostami,Elham, PY - 2016/12/3/pubmed PY - 2018/8/7/medline PY - 2016/12/2/entrez SP - 49 EP - 58 JF - Journal of neurosurgical anesthesiology JO - J Neurosurg Anesthesiol VL - 30 IS - 1 N2 - BACKGROUND: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome. MATERIALS AND METHODS: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3. RESULTS: Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBF<20 mL/100 g/min was detected in more than 10% of the region-of-interest (ROI) area and in 17 patients such low-flow area exceeded 30%. rCBF was not related to the localization of the aneurysm; there was no difference in rCBF of ipsilateral compared with contralateral vascular territories. In patients who initially were in Hunt & Hess grade I to III, median global CBF day 0 to 3 was significantly lower for patients who were in poor neurological state at discharge compared with patients in good neurological state, 25.5 mL/100 g/min (IQR, 21.3 to 28.3) versus 37.8 mL/100 g/min (IQR, 30.5 to 47.6). CONCLUSIONS: CBF disturbances are common in the early phase after SAH. In many patients, CBF was heterogenic and substantial areas with low rCBF were detected. Age and CT Fisher grade were factors influencing global cortical CBF. Bedside XeCT may be a tool to identify patients at risk of deteriorating so they can receive intensified management, but this needs further exploration. SN - 1537-1921 UR - https://www.unboundmedicine.com/medline/citation/27906765/Hemodynamic_Disturbances_in_the_Early_Phase_After_Subarachnoid_Hemorrhage:_Regional_Cerebral_Blood_Flow_Studied_by_Bedside_Xenon_enhanced_CT_ L2 - http://dx.doi.org/10.1097/ANA.0000000000000395 DB - PRIME DP - Unbound Medicine ER -