• Neurocritical care · Dec 2013

    Response of Brain Oxygen to Therapy Correlates with Long-Term Outcome After Subarachnoid Hemorrhage.

    • Leif-Erik Bohman, Jared M Pisapia, Matthew R Sanborn, Suzanne Frangos, Elsa Lin, Monisha Kumar, Soojin Park, W Andrew Kofke, Michael F Stiefel, Peter D LeRoux, and Joshua M Levine.
    • Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
    • Neurocrit Care. 2013 Dec 1;19(3):320-8.

    BackgroundBrain oxygen (PbtO2) monitoring can help guide care of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients. The relationship between PbtO2-directed therapy and long-term outcome is unclear. We hypothesized that responsiveness to PbtO2-directed interventions is associated with outcome.MethodsSeventy-six aSAH patients who underwent PbtO2 monitoring were included. Long-term outcome [Glasgow Outcome Score-Extended (GOS-E) and modified Rankin Scale (mRS)] was ascertained using the social security death database and structured telephone interviews. Univariate and multivariate regression were used to identify variables that correlated with outcome.ResultsData from 64 patients were analyzed (12 were lost to follow-up). There were 530 episodes of compromised PbtO2 (<20 mmHg) during a total of 7,174 h of monitor time treated with 1,052 interventions. Forty-two patients (66 %) survived to discharge. Median follow-up was 8.5 months (range 0.1-87). At most recent follow-up 35 (55 %) patients were alive, and 28 (44 %) had a favorable outcome (mRS ≤3). In multivariate ordinal regression analysis, only age and response to PbtO2-directed intervention correlated significantly with outcome. Increased age was associated with worse outcome (coeff. 0.8, 95 % CI 0.3-1.3, p = 0.003), and response to PbtO2-directed intervention was associated with improved outcome (coeff. -2.12, 95 % CI -4.0 to -0.26, p = 0.03). Patients with favorable outcomes had a 70 % mean rate of response to PbtO2-directed interventions whereas patients with poor outcomes had a 45 % response rate (p = 0.005).ConclusionsResponse to PbtO2-directed intervention is associated with improved long-term functional outcome in aSAH patients.

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