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Effect of HHH-Therapy on Regional CBF after Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT.
Neurocrit Care. 2018 04; 28(2):143-151.NC

Abstract

BACKGROUND

Management of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is difficult and still carries controversies. In this study, the effect of therapeutic hypervolemia, hemodilution, and hypertension (HHH-therapy) on cerebral blood flow (CBF) was assessed by xenon-enhanced computerized tomography (XeCT) hypothesizing an increase in CBF in poorly perfused regions.

METHODS

Bedside XeCT measurements of regional CBF in mechanically ventilated SAH patients were routinely scheduled for day 0-3, 4-7, and 8-12. At clinical suspicion of DCI, patients received 5-day HHH-therapy. For inclusion, XeCT was required at 0-48 h before start of HHH (baseline) and during therapy. Data from corresponding time-windows were also collected for non-DCI patients.

RESULTS

Twenty patients who later developed DCI were included, and twenty-eight patients without DCI were identified for comparison. During HHH, there was a slight nonsignificant increase in systolic blood pressure (SBP) and a significant reduction in hematocrit. Median global cortical CBF for the DCI group increased from 29.5 (IQR 24.6-33.9) to 38.4 (IQR 27.0-41.2) ml/100 g/min (P = 0.001). There was a concomitant increase in regional CBF of the worst vascular territories, and the proportion of area with blood flow below 20 ml/100 g/min was significantly reduced. Non-DCI patients showed higher CBF at baseline, and no significant change over time.

CONCLUSIONS

HHH-therapy appeared to increase global and regional CBF in DCI patients. The increase in SBP was small, while the decrease in hematocrit was more pronounced, which may suggest that intravascular volume status and rheological effects are of importance. XeCT may be potentially helpful in managing poor-grade SAH patients.

Authors+Show Affiliations

Dept of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden. henrik.engquist@akademiska.se. Dept of Surgical Sciences/Anesthesia and Intensive Care, Uppsala University Hospital, 751 85, Uppsala, Sweden. henrik.engquist@akademiska.se.Dept of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Dept of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Dept of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Dept of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.Dept of Neuroscience/Neurosurgery, Uppsala University, Uppsala, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28983856

Citation

Engquist, Henrik, et al. "Effect of HHH-Therapy On Regional CBF After Severe Subarachnoid Hemorrhage Studied By Bedside Xenon-Enhanced CT." Neurocritical Care, vol. 28, no. 2, 2018, pp. 143-151.
Engquist H, Rostami E, Ronne-Engström E, et al. Effect of HHH-Therapy on Regional CBF after Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT. Neurocrit Care. 2018;28(2):143-151.
Engquist, H., Rostami, E., Ronne-Engström, E., Nilsson, P., Lewén, A., & Enblad, P. (2018). Effect of HHH-Therapy on Regional CBF after Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT. Neurocritical Care, 28(2), 143-151. https://doi.org/10.1007/s12028-017-0439-y
Engquist H, et al. Effect of HHH-Therapy On Regional CBF After Severe Subarachnoid Hemorrhage Studied By Bedside Xenon-Enhanced CT. Neurocrit Care. 2018;28(2):143-151. PubMed PMID: 28983856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of HHH-Therapy on Regional CBF after Severe Subarachnoid Hemorrhage Studied by Bedside Xenon-Enhanced CT. AU - Engquist,Henrik, AU - Rostami,Elham, AU - Ronne-Engström,Elisabeth, AU - Nilsson,Pelle, AU - Lewén,Anders, AU - Enblad,Per, PY - 2017/10/7/pubmed PY - 2019/10/1/medline PY - 2017/10/7/entrez KW - Cerebral blood flow (CBF) KW - Delayed cerebral ischemia (DCI) KW - HHH-therapy (Triple-H) KW - Subarachnoid hemorrhage (SAH) KW - Xenon CT (XeCT) SP - 143 EP - 151 JF - Neurocritical care JO - Neurocrit Care VL - 28 IS - 2 N2 - BACKGROUND: Management of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is difficult and still carries controversies. In this study, the effect of therapeutic hypervolemia, hemodilution, and hypertension (HHH-therapy) on cerebral blood flow (CBF) was assessed by xenon-enhanced computerized tomography (XeCT) hypothesizing an increase in CBF in poorly perfused regions. METHODS: Bedside XeCT measurements of regional CBF in mechanically ventilated SAH patients were routinely scheduled for day 0-3, 4-7, and 8-12. At clinical suspicion of DCI, patients received 5-day HHH-therapy. For inclusion, XeCT was required at 0-48 h before start of HHH (baseline) and during therapy. Data from corresponding time-windows were also collected for non-DCI patients. RESULTS: Twenty patients who later developed DCI were included, and twenty-eight patients without DCI were identified for comparison. During HHH, there was a slight nonsignificant increase in systolic blood pressure (SBP) and a significant reduction in hematocrit. Median global cortical CBF for the DCI group increased from 29.5 (IQR 24.6-33.9) to 38.4 (IQR 27.0-41.2) ml/100 g/min (P = 0.001). There was a concomitant increase in regional CBF of the worst vascular territories, and the proportion of area with blood flow below 20 ml/100 g/min was significantly reduced. Non-DCI patients showed higher CBF at baseline, and no significant change over time. CONCLUSIONS: HHH-therapy appeared to increase global and regional CBF in DCI patients. The increase in SBP was small, while the decrease in hematocrit was more pronounced, which may suggest that intravascular volume status and rheological effects are of importance. XeCT may be potentially helpful in managing poor-grade SAH patients. SN - 1556-0961 UR - https://www.unboundmedicine.com/medline/citation/28983856/Effect_of_HHH_Therapy_on_Regional_CBF_after_Severe_Subarachnoid_Hemorrhage_Studied_by_Bedside_Xenon_Enhanced_CT_ L2 - https://dx.doi.org/10.1007/s12028-017-0439-y DB - PRIME DP - Unbound Medicine ER -