Options for Continual Cerebral Blood Flow Monitoring to Detect Vasospasms in Patients after Severe Subarachnoid Haemorrhage

Czech version

Authors: A. Mrlian ¹; K. Ďuriš ^1,2; E. Neuman ¹; V. Vybíhal ¹ ; M. Smrčka ¹
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno ¹; Ústav patologické fyziologie LF MU, Brno ²
Published in: Cesk Slov Neurol N 2014; 77/110(3): 326-332
Category: Original Paper

Práce byla sponzorována grantem IG MZ ČR č. NT 11092– 4.

Overview

Introduction:
Intensive care seems to be as important for prognosis after ruptured aneurysm and subarachnoid haemorrhage as early diagnosis and treatment of the aneurysm. Higher morbidity and mortality is typical in patients with clinical status corresponding to a higher Hunt and Hess grade. Multimodal monitoring would allow early detailed assessment of the patient’s actual clinical status and enable timely initiation of an appropriate therapy.

Material and methods:
A total number of 29 patients HH grade IV + V were monitored. Due to technical and procedural errors, 17 patients were finally analyzed. The objective was to measure the correlation between clinical status, outcome, tissue oxygen levels and TCD with respect to direct measurement of cerebral blood flow.

Results:
No statistically significant correlation was found between the mean values of CBF (for the entire monitoring period) and the HH grade, Fisher and GOS In the examined group. Correlation between CBF and PbtO₂ varied widely between patients (r = 0.16–0.65). There was not significant correlation in the research sample between CBF and flow parameters of the main vessels (PSV, EDV, Vmean, p = NS for all parameters). Furthermore, no significant correlation was found in the research sample between CBF and resistivity and pulsatility indices (PI, RI, p = NS) but there was a trend towards indirect correlation between CBF and RI (r = –0.3844, p = 0.0786).

Conclusion:
Comprehensive monitoring of patients after subarachnoid haemorrhage provides a broad picture of the processes running in the damaged brain tissue and improves intensive treatment. However, direct measurement of CBF has, according to our findings, inconsistent value for the diagnosis of vasospasm and patient evaluation. Therefore, this cannot be used as a basis for therapy choices in these patients.

Key words:
subarachnoid haemorrhage – multimodal monitoring – cerebral blood flow

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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