nach oben

Neurocritical Care

Erschienen in:

01.04.2014 | Original Article

Fluid Responsiveness and Brain Tissue Oxygen Augmentation After Subarachnoid Hemorrhage

Erschienen in: Neurocritical Care | Ausgabe 2/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

The objective of this study was to investigate the relationship between cardiac index (CI) response to a fluid challenge and changes in brain tissue oxygen pressure (PbtO₂) in patients with subarachnoid hemorrhage (SAH).

Methods

Prospective observational study was conducted in a neurological intensive care unit of a university hospital. Fifty-seven fluid challenges were administered to ten consecutive comatose SAH patients that underwent multimodality monitoring of CI, intracranial pressure (ICP), and PbtO₂, according to a standardized fluid management protocol.

Results

The relationship between CI and PbtO₂ was analyzed with logistic regression utilizing generalized estimating equations. Of the 57 fluid boluses analyzed, 27 (47 %) resulted in a ≥ 10 % increase in CI. Median absolute (+5.8 vs. +1.3 mmHg) and percent (20.7 vs. 3.5 %) changes in PbtO₂ were greater in CI responders than in non-responders within 30 min after the end of the fluid bolus infusion. In a multivariable model, a CI response was independently associated with PbtO₂ response (adjusted odds ratio 21.5, 95 % CI 1.4–324, P = 0.03) after adjusting for mean arterial pressure change and end-tidal CO₂. Stroke volume variation showed a good ability to predict CI and PbtO₂ response with areas under the ROC curve of 0.86 and 0.81 with the best cut-off values of 9 % for both responses.

Conclusion

Bolus fluid resuscitation resulting in augmentation of CI can improve cerebral oxygenation after SAH.

Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121:2000–8.PubMedCrossRef

Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.PubMedCrossRef

Rivers EP. Early goal-directed therapy in severe sepsis and septic shock: converting science to reality. Chest. 2006;129:217–8.PubMedCrossRef

Claassen J, Hirsch LJ, Kreiter KT, et al. Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage. Clin Neurophysiol. 2004;115:2699–710.PubMedCrossRef

Botteri M, Bandera E, Minelli C, Latronico N. Cerebral blood flow thresholds for cerebral ischemia in traumatic brain injury. A systematic review. Crit Care Med. 2008;36:3089–92.PubMedCrossRef

Coles JP. Regional ischemia after head injury. Curr Opin Crit Care. 2004;10:120–5.PubMedCrossRef

Janjua N, Mayer SA. Cerebral vasospasm after subarachnoid hemorrhage. Curr Opin Crit Care. 2003;9:113–9.PubMedCrossRef

Zazulia AR, Diringer MN, Videen TO, et al. Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab. 2001;21:804–10.PubMedCrossRef

Robertson CS, Valadka AB, Hannay HJ, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999;27:2086–95.PubMedCrossRef

10.

Johnston AJ, Steiner LA, Coles JP, et al. Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med. 2005;33:189–95 discussion 255–7.PubMedCrossRef

11.

Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. X. Brain oxygen monitoring and thresholds. J Neurotrauma. 2007;24(Suppl 1):S65–70.PubMed

12.

Muench E, Horn P, Bauhuf C, et al. Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med. 2007;35:1844–51 quiz 52.PubMedCrossRef

13.

White H, Venkatesh B. Cerebral perfusion pressure in neurotrauma: a review. Anesth Analg. 2008;107:979–88.PubMedCrossRef

14.

Bederson JB, Connolly ES Jr, Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40:994–1025.PubMedCrossRef

15.

Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation. 2007;116:e391–413.PubMedCrossRef

16.

Otero RM, Nguyen HB, Huang DT, et al. Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings. Chest. 2006;130:1579–95.PubMedCrossRef

17.

Berkowitz DM, Danai PA, Eaton S, Moss M, Martin GS. Accurate characterization of extravascular lung water in acute respiratory distress syndrome. Crit Care Med. 2008;36:1803–9.PubMedCentralPubMedCrossRef

18.

Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75.PubMedCrossRef

19.

Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12:R74.PubMedCentralPubMedCrossRef

20.

Lennihan L, Mayer SA, Fink ME, et al. Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: a randomized controlled trial. Stroke. 2000;31:383–91.PubMedCrossRef

21.

Contant CF, Valadka AB, Gopinath SP, Hannay HJ, Robertson CS. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg. 2001;95:560–8.PubMedCrossRef

22.

Wartenberg KE, Schmidt JM, Claassen J, et al. Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med. 2006;34:617–23 quiz 24.PubMedCrossRef

23.

Mayer SA, Fink ME, Homma S, et al. Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemorrhage. Neurology. 1994;44:815–20.PubMedCrossRef

24.

Mascia L, Sakr Y, Pasero D, Payen D, Reinhart K, Vincent JL. Extracranial complications in patients with acute brain injury: a post hoc analysis of the SOAP study. Intensive Care Med. 2008;34:720–7.PubMedCrossRef

25.

Schmidt JM, Wartenberg KE, Fernandez A, et al. Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage. J Neurosurg. 2008;109:1052–9.PubMedCrossRef

26.

Mayer J, Boldt J, Schollhorn T, Rohm KD, Mengistu AM, Suttner S. Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth. 2007;98:176–82.PubMedCrossRef

27.

de Waal EE, Kalkman CJ, Rex S, Buhre WF. Validation of a new arterial pulse contour-based cardiac output device. Crit Care Med. 2007;35:1904–9.PubMedCrossRef

28.

Ostergaard M, Nielsen J, Rasmussen JP, Berthelsen PG. Cardiac output–pulse contour analysis vs. pulmonary artery thermodilution. Acta Anaesthesiol Scand. 2006;50:1044–9.PubMedCrossRef

29.

Wan L, Naka T, Uchino S, Bellomo R. A pilot study of pulse contour cardiac output monitoring in patients with septic shock. Crit Care Resusc. 2005;7:165.PubMed

30.

Rose JC, Neill TA, Hemphill JC 3rd. Continuous monitoring of the microcirculation in neurocritical care: an update on brain tissue oxygenation. Curr Opin Crit Care. 2006;12:97–102.PubMedCrossRef

31.

Stewart C, Haitsma I, Zador Z, et al. The new Licox combined brain tissue oxygen and brain temperature monitor: assessment of in vitro accuracy and clinical experience in severe traumatic brain injury. Neurosurgery. 2008;63:1159–64 discussion 64–5.PubMedCrossRef

32.

Jaeger M, Soehle M, Schuhmann MU, Winkler D, Meixensberger J. Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir (Wien). 2005;147:51–6 discussion 6.CrossRef

33.

Lee SK, Morabito D, Hemphill JC, et al. Small-volume resuscitation with HBOC-201: effects on cardiovascular parameters and brain tissue oxygen tension in an out-of-hospital model of hemorrhage in swine. Acad Emerg Med. 2002;9:969–76.PubMedCrossRef

34.

Manley GT, Hemphill JC, Morabito D, et al. Small-volume resuscitation with the hemoglobin substitute HBOC-201: effect on brain tissue oxygenation. Adv Exp Med Biol. 2003;530:311–7.PubMedCrossRef

35.

Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European stroke organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35:93–112.PubMedCrossRef

36.

Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–37.PubMedCrossRef

37.

Badjatia N, Strongilis E, Gordon E, et al. Metabolic impact of shivering during therapeutic temperature modulation: the bedside shivering assessment scale. Stroke. 2008;39:3242–7.PubMedCrossRef

38.

Badjatia N, Strongilis E, Prescutti M, et al. Metabolic benefits of surface counter warming during therapeutic temperature modulation. Crit Care Med. 2009;37:1893–7.PubMedCrossRef

39.

Choi HA, Ko SB, Presciutti M, et al. Prevention of shivering during therapeutic temperature modulation: the columbia anti-shivering protocol. Neurocrit Care. 2011;14:389–94.PubMedCrossRef

40.

Oddo M, Nduom E, Frangos S, et al. Acute lung injury is an independent risk factor for brain hypoxia after severe traumatic brain injury. Neurosurgery. 2010;67:338–44.PubMedCrossRef

41.

Mutoh T, Kazumata K, Ajiki M, Ushikoshi S, Terasaka S. Goal-directed fluid management by bedside transpulmonary hemodynamic monitoring after subarachnoid hemorrhage. Stroke. 2007;38:3218–24.PubMedCrossRef

42.

Jost SC, Diringer MN, Zazulia AR, et al. Effect of normal saline bolus on cerebral blood flow in regions with low baseline flow in patients with vasospasm following subarachnoid hemorrhage. J Neurosurg. 2005;103:25–30.PubMedCrossRef

43.

Joseph M, Ziadi S, Nates J, Dannenbaum M, Malkoff M. Increases in cardiac output can reverse flow deficits from vasospasm independent of blood pressure: a study using xenon computed tomographic measurement of cerebral blood flow. Neurosurgery. 2003;53:1044–51 discussion 51–2.PubMedCrossRef

44.

Zweifel C, Castellani G, Czosnyka M, et al. Continuous assessment of cerebral autoregulation with near-infrared spectroscopy in adults after subarachnoid hemorrhage. Stroke. 2010;41:1963–8.PubMedCrossRef

45.

Jaeger M, Soehle M, Schuhmann MU, Meixensberger J. Clinical significance of impaired cerebrovascular autoregulation after severe aneurysmal subarachnoid hemorrhage. Stroke. 2012;43:2097–101.PubMedCrossRef

46.

Auler JO Jr, Galas F, Hajjar L, Santos L, Carvalho T, Michard F. Online monitoring of pulse pressure variation to guide fluid therapy after cardiac surgery. Anesth Analg. 2008;106:1201–6 table of contents.PubMedCrossRef

47.

Michard F, Boussat S, Chemla D, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med. 2000;162:134–8.PubMedCrossRef

48.

Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg. 2001;92:984–9.PubMedCrossRef

49.

Carrera E, Kurtz P, Badjatia N, et al. Cerebrovascular carbon dioxide reactivity and delayed cerebral ischemia after subarachnoid hemorrhage. Arch Neurol. 2010;67:434–9.PubMed

50.

Schmidt JM, Ko SB, Helbok R, et al. Cerebral perfusion pressure thresholds for brain tissue hypoxia and metabolic crisis after poor-grade subarachnoid hemorrhage. Stroke. 2011;42:1351–6.PubMedCentralPubMedCrossRef

51.

Dhar R, Scalfani MT, Zazulia AR, Videen TO, Derdeyn CP, Diringer MN. Comparison of induced hypertension, fluid bolus, and blood transfusion to augment cerebral oxygen delivery after subarachnoid hemorrhage. J Neurosurg. 2012;116:648–56.PubMedCentralPubMedCrossRef

52.

Dhar R, Zazulia AR, Videen TO, Zipfel GJ, Derdeyn CP, Diringer MN. Red blood cell transfusion increases cerebral oxygen delivery in anemic patients with subarachnoid hemorrhage. Stroke. 2009;40:3039–44.PubMedCentralPubMedCrossRef

Titel: Fluid Responsiveness and Brain Tissue Oxygen Augmentation After Subarachnoid Hemorrhage
Publikationsdatum: 01.04.2014
Erschienen in: Neurocritical Care / Ausgabe 2/2014
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-013-9910-6

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2014

Differential Disruption of Blood–Brain Barrier in Severe Traumatic Brain Injury

Association of Intraprocedural Blood Pressure and End Tidal Carbon Dioxide with Outcome After Acute Stroke Intervention

Standards of Scoring, Monitoring, and Parameter Targeting in German Neurocritical Care Units: A National Survey

Chronic Traumatic Encephalopathy: A Critical Appraisal

Glibenclamide in Cerebral Ischemia and Stroke