uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Secondary insults in subarachnoid hemorrhage: occurrence and impact on outcome and clinical deterioration
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Show others and affiliations
2007 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 61, no 4, 704-714 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study the occurrence of secondary insults during neurointensive care of patients with subarachnoid hemorrhage using a computerized multimodality monitoring system and to study the impact of secondary insults on clinical deterioration and functional outcome.

METHODS: Patients with subarachnoid hemorrhage who were admitted to the neurointensive care unit between January 1999 and December 2002 with at least 120 hours of multimodality monitoring data within the first 240 hours of neurointensive care were included. Data were continuously recorded for intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure, systolic blood pressure, oxygen saturation, and temperature. Secondary insult levels were defined as ICP of 20 or greater or 25 or greater; CPP of 60 or lower, 55 or lower, greater than 100, or greater than 110; mean arterial blood pressure of 80 or lower, 70 or lower, 120 or greater, or 130 or greater; systolic blood pressure of 110 or lower, 100 or lower, 180 or greater, or 200 or greater; temperature of 38°C or higher or 39°C or higher; and oxygen saturation of less than 95 or less than 90. Secondary insults were quantified as the proportion of good monitoring time at the insult level. Uni- and multivariate logistic regression analyses were performed with admission and secondary insult variables as explanatory variables and clinical deterioration and independent outcome as the dependent variable, respectively.

RESULTS: Ninety-nine patients (67 women; mean age, 57.8 yr) met the inclusion criteria. In the univariate analysis, ICP of 20 or greater, ICP of 25 or greater, CPP of 60 or less, and CPP of 55 or less increased the risk of clinical deterioration, whereas CPP greater than 100 and systolic blood pressure greater than 180 decreased the risk of clinical deterioration. In the multivariate logistic regression, ICP of 25 or greater and CPP of greater than 100 had an independent effect on clinical deterioration. The occurrence of secondary insults had no significant effect on functional outcome.

CONCLUSION: Elevated ICP not responding to treatment is predictive of clinical deterioration, whereas high CPP decreases the risk of clinical deterioration. It may be beneficial to not lower spontaneous high CPP in patients with subarachnoid hemorrhage.

Place, publisher, year, edition, pages
2007. Vol. 61, no 4, 704-714 p.
Keyword [en]
Multimodality monitoring, Outcome, Secondary insults, Subarachnoid hemorrhage
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-97924DOI: 10.1227/01.NEU.0000298898.38979.E3ISI: 000250577400005PubMedID: 17986931OAI: oai:DiVA.org:uu-97924DiVA: diva2:173044
Available from: 2008-12-19 Created: 2008-12-19 Last updated: 2016-05-02Bibliographically approved
In thesis
1. Subarachnoid Hemorrhage in the Elderly
Open this publication in new window or tab >>Subarachnoid Hemorrhage in the Elderly
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Subarachnoid hemorrhage (SAH) is a disease with high risk of mortality and morbidity. Elderly patients have an even higher risk of poor outcome. The incidence of SAH increases with age and the elderly constitute a substantial and increasing proportion of the population. Thus, the management of elderly SAH patients is an imminent clinical challenge. Time trends in clinical management and outcome were investigated in 281 SAH patients aged ≥65 years admitted over an 18-year period. The volume of elderly patients, especially patients ≥70 years and patients in worse clinical condition increased over time. The proportion of patients with favorable outcome increased over time, without an increase in severely disabled patients. Technical results and clinical outcome of endovascular aneurysm treatment (EVT) was investigated in 62 elderly SAH patients. EVT can be performed in elderly SAH patients with high technical success, acceptable aneurysm occlusion degree, acceptable procedural complication rate, and fair outcome results. EVT was compared to neurosurgical clipping (NST) in 278 elderly SAH patients in the International Subarachnoid Aneurysm Trial. In good grade elderly SAH patients, EVT should probably be the favored treatment for internal carotid and posterior communicating artery aneurysms, while elderly patients with middle cerebral artery aneurysms appear to benefit from NST. Occurrence of secondary insults and their impact on clinical deterioration were studied in 99 patients with severe SAH. High intracranial pressure increased and high cerebral perfusion pressure decreased the risk of clinical deterioration. Elderly patients had less intracranial hypertension insults and more hypertensive, hypotensive and hypoxemic insults. Good outcome was achieved in 24% of elderly patients with severe SAH, and the proportion of severe disability was similar to that of younger patients. Patient age was not a significant predictor for vasospasm in 413 SAH patients when admission and treatment variables were adjusted for with multiple logistic regression.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 106 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 407
subarachnoid hemorrhage, intracranial aneurysm, elderly, outcome, endovascular coiling, neurosurgical clipping, secondary insult, cerebral vasospasm
National Category
urn:nbn:se:uu:diva-9504 (URN)978-91-554-7375-4 (ISBN)
Public defence
2009-01-09, Enghoffsalen, Akademiska sjukhuset, ing 50, Uppsala, 09:15
Available from: 2008-12-19 Created: 2008-12-19 Last updated: 2011-01-12Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Ryttlefors, Mats
By organisation
Department of Neuroscience
In the same journal
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 231 hits
ReferencesLink to record
Permanent link

Direct link