Intracranial pressure after subarachnoid hemorrhage.
Crit Care Med
; 43(1): 168-76, 2015 Jan.
Article
en En
| MEDLINE
| ID: mdl-25318385
ABSTRACT
OBJECTIVES:
To describe mean intracranial pressure after aneurysmal subarachnoid hemorrhage, to identify clinical factors associated with increased mean intracranial pressure, and to explore the relationship between mean intracranial pressure and outcome.DESIGN:
Analysis of a prospectively collected observational database.SETTING:
Neuroscience ICU of an academic hospital. PATIENTS One hundred sixteen patients with subarachnoid hemorrhage and intracranial pressure monitoring.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
Episodes of intracranial pressure greater than 20 mm Hg lasting at least 5 minutes and the mean intracranial pressure for every 12-hour interval were analyzed. The highest mean intracranial pressure was analyzed in relation to demographic characteristics, acute neurologic status, initial radiological findings, aneurysm treatment, clinical vasospasm, and ischemic lesion. Mortality and 6-month outcome (evaluated using a dichotomized Glasgow Outcome Scale) were also introduced in multivariable logistic models. Eighty-one percent of patients had at least one episode of high intracranial pressure and 36% had a highest mean intracranial pressure more than 20 mm Hg. The number of patients with high intracranial pressure peaked 3 days after subarachnoid hemorrhage and declined after day 7. Highest mean intracranial pressure greater than 20 mm Hg was significantly associated with initial neurologic status, aneurysmal rebleeding, amount of blood on CT scan, and ischemic lesion within 72 hours from subarachnoid hemorrhage. Patients with highest mean intracranial pressure greater than 20 mm Hg had significantly higher mortality. When death, vegetative state, and severe disability at 6 months were pooled, however, intracranial pressure was not an independent predictor of unfavorable outcome.CONCLUSIONS:
High intracranial pressure is a common complication in the first week after subarachnoid hemorrhage in severe cases admitted to ICU. Mean intracranial pressure is associated with the severity of early brain injury and with mortality.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Hemorragia Subaracnoidea
/
Presión Intracraneal
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Crit Care Med
Año:
2015
Tipo del documento:
Article
País de afiliación:
Italia