PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage

GND
1077613148
ORCID
0000-0003-1021-5024
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Darkwah Oppong, Marvin;
GND
132876884
ORCID
0000-0001-7076-3503
LSF
56161
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Wrede, Karsten H.;
LSF
13059
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Müller, Daniela;
GND
1249931215
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Santos, Alejandro N.;
GND
1236439961
ORCID
0000-0001-8348-4298
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Rauschenbach, Laurèl;
GND
1201695538
ORCID
0000-0002-7009-9099
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Dinger, Thiemo F.;
GND
1169755739
ORCID
0000-0003-3759-8301
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Ahmadipour, Yahya;
GND
174037228
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Pierscianek, Daniela;
GND
1213270154
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Chihi, Mehdi;
GND
1139059009
ORCID
0000-0002-3906-9481
LSF
63350
Zugehörige Organisation
Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Li, Yan;
GND
1213546338
ORCID
0000-0001-9262-7289
LSF
63347
Zugehörige Organisation
Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Deuschl, Cornelius;
GND
113528884
ORCID
0000-0002-9073-1821
LSF
50510
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Sure, Ulrich;
GND
133245179
ORCID
0000-0002-8356-6629
Zugehörige Organisation
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Jabbarli, Ramazan
The partial pressure of carbon dioxide (PaCO2) in the arterial blood is a strong vasomodulator affecting cerebral blood flow and the risk of cerebral edema and ischemia after acute brain injury. In turn, both complications are related to poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to analyze the effect of PaCO2 levels on the course and outcome of aSAH. All patients of a single institution treated for aSAH over 13.5 years were included (n = 633). Daily PaCO2 values from arterial blood gas measurements were recorded for up to 2 weeks after ictus. The study endpoints were: delayed cerebral ischemia (DCI), need for decompressive craniectomy due to increased intracranial pressure > 20 mmHg refractory to conservative treatment and poor outcome at 6-months follow-up (modified Rankin scale > 2). By correlations with the study endpoints, clinically relevant cutoffs for the 14-days mean values for the lowest and highest daily PaCO2 levels were defined by receiver operating characteristic curve analysis. Association with the study endpoints for the identifies subgroups was analyzed using multivariate analysis. The optimal range for PaCO2 values was identified between 30 and 38 mmHg. ASAH patients with poor initial condition (WFNS 4/5) were less likely to show PaCO2 values within the range of 30–38 mmHg ( p  < 0.001, OR = 0.44). In the multivariate analysis, PaCO2 values between 30 and 38 mmHg were associated with a lower risk for decompressive craniectomy ( p  = 0.042, aOR = 0.27), DCI occurrence ( p  = 0.035; aOR = 0.50), and poor patient outcome ( p  = 0.004; aOR = 0.42). The data from this study shows an independent positive association between low normal mean PaCO2 values during the acute phase of aSAH and patients’ outcome. This effect might be attributed to the reduction of intracranial hypertension and alterations in the cerebral blood flow.

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