000K utf8 1100 2021$c2021-09-28 1500 eng 2050 urn:nbn:de:hbz:465-20240905-113244-8 2051 10.1038/s41598-021-98462-2 3000 Darkwah Oppong, Marvin 3010 Ahmadipour, Yahya 3010 Chihi, Mehdi 3010 Deuschl, Cornelius 3010 Dinger, Thiemo F. 3010 Jabbarli, Ramazan 3010 Li, Yan 3010 Müller, Daniela 3010 Pierscianek, Daniela 3010 Rauschenbach, Laurèl 3010 Santos, Alejandro N. 3010 Sure, Ulrich 3010 Wrede, Karsten H. 4000 PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage [Darkwah Oppong, Marvin] 4209 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. 4950 https://doi.org/10.1038/s41598-021-98462-2$xR$3Volltext$534 4950 https://nbn-resolving.org/urn:nbn:de:hbz:465-20240905-113244-8$xR$3Volltext$534 4961 https://duepublico2.uni-due.de/receive/duepublico_mods_00078033 5051 610 5550 Cerebrovascular disorders 5550 Neurovascular disorders 5550 Stroke