Target intracranial pressure among patients with aneurysmal subarachnoid hemorrhage: A prospective single-center study - 28/02/20
, Kevin Chalard, MD 2, Pierre-Henri Lefevre, MD 1, Imad Derraz, MD 1, Cyril Dargazanli, MD 1, Gregory Gascou, MD 1, Carlos Riquelme, MD 1, Alain Bonafe, MD 1, Paolo Perrini, MD 3, Marine Le Corre, MD 4, Pierre-Francois Perrigault, MD 2, Vincent Costalat, MD 1Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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Resumen |
Background |
Management of external ventricular drainage (EVD) among aneurysmal subarachnoid hemorrhage (aSAH) patients remain controversial, and there are no consensus guidelines reporting optimal values of intracranial pressure (ICP).
Objective |
To analyze predictors of delayed cerebral ischemia (DCI) after aSAH and the influence of ICP values on DCI.
Methods |
We prospectively collected patients with aSAH requiring EVD. Predictors of DCI (new CT hypodensities developed within the first 3 weeks not related to others causes) were studied. Vasospasm and brain hypoperfusion were studied with CTA and CTP (RAPID software).
Results |
Among 50 aSAH patients treated with EVD, 21 (42%) developed DCI, while 27 (54%) presented vasospasm. Mean ICP ranged between 2mmHg and 19mmHg. On the multivariate analysis, mean ICP (OR=2, 95% CI=1.01–3.9, P=0.04) and mean volume of the hypoperfusion on Tmax delay>6 (OR=1.2, 95% CI=1.01–1.3, P=0.02) were the only independent predictors of DCI. To predict DCI, Tmax delay>6seconds presented the highest AUC (0.956), with a cutoff value of 18mL showing sensitivity, specificity, PPV, NPV, and accuracy of 90.5% (95% CI=69%–98.8%), 86.2% (95% CI=68.4%–96%), 82.6% (95% CI=65.4%–92%), 92.5% (95% CI=77%–98%), 88% (95% CI=75%–95%), respectively. The AUC of the mean ICP was 0.825, and the best cutoff value was 6.7mmHg providing sensitivity, specificity, PPV, NPV, and accuracy of 71.4% (95% CI=48%–89%), 62% (95% CI=42%–79%), 58% (95% CI=44%–70%), 75% (95% CI=59%–86%), 66% (95% CI=51%–79%) for the prediction of DCI, respectively.
Conclusion |
ICP<7mmHg could potentially be beneficial in decreasing DCI. Whole-brain CTP allows a reliable DCI prediction, and a hypoperfusion volume larger than 18mL at Tmax delay>6seconds can predict more than 80% of DCI (Fig. 1, Fig. 2).
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Vol 47 - N° 2
P. 103-104 - mars 2020 Regresar al número
Artículo precedente
- Comparison between prasugrel and clopidogrel used as antiplatelet medication for endovascular treatment of unruptured intracranial aneurysms. A meta-analysis
- Federico Cagnazzo, Paolo Perrini, Pierre-Henri Lefevre, Gregory Gascou, Cyril Dargazanli, Carlos Riquelme, Imad Derraz, Davide di Carlo, Alain Bonafe, Vincent Costalat
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- Federico Cagnazzo, Raed Ahmed, Riccardo Zannoni, Cyril Dargazanli, Pierre-Henri Lefevre, Gregory Gascou, Imad Derraz, Carlos Riquelme, Alain Bonafe, Vincent Costalat
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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