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Early brain injury after aneurysmal subarachnoid hemorrhage: a multimodal neuromonitoring study.
- Source :
-
Critical care (London, England) [Crit Care] 2015 Mar 09; Vol. 19, pp. 75. Date of Electronic Publication: 2015 Mar 09. - Publication Year :
- 2015
-
Abstract
- Introduction: There is a substantial amount of evidence from animal models that early brain injury (EBI) may play an important role for secondary brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Cerebral microdialysis (CMD) allows online measurement of brain metabolites, including the pro-inflammatory cytokine interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9), which is indicative for disruption of the blood-brain barrier.<br />Methods: Twenty-six consecutive poor-grade aSAH patients with multimodal neuromonitoring were analyzed for brain hemodynamic and metabolic changes, including CMD-IL-6 and CMD-MMP-9 levels. Statistical analysis was performed by using a generalized estimating equation with an autoregressive function.<br />Results: The baseline cerebral metabolic profile revealed brain metabolic distress and an excitatory response which improved over the following 5 days (P <0.001). Brain tissue hypoxia (brain tissue oxygen tension of less than 20 mm Hg) was common (more than 60% of patients) in the first 24 hours of neuromonitoring and improved thereafter (P <0.05). Baseline CMD-IL-6 and CMD-MMP-9 levels were elevated in all patients (median = 4,059 pg/mL, interquartile range (IQR) = 1,316 to 12,456 pg/mL and median = 851 pg/mL, IQR = 98 to 25,860 pg/mL) and significantly decreased over days (P <0.05). A higher pro-inflammatory response was associated with the development of delayed cerebral ischemia (P = 0.04), whereas admission disease severity and early brain tissue hypoxia were associated with higher CMD-MMP-9 levels (P <0.03). Brain metabolic distress and increased IL-6 levels were associated with poor functional outcome (modified Rankin Scale of more than 3, P ≤0.01). All models were adjusted for probe location, aneurysm securing procedure, and disease severity as appropriate.<br />Conclusions: Multimodal neuromonitoring techniques allow insight into pathophysiologic changes in the early phase after aSAH. The results may be used as endpoints for future interventions targeting EBI in poor-grade aSAH patients.
- Subjects :
- Aged
Blood-Brain Barrier metabolism
Brain Ischemia etiology
Critical Illness
Female
Humans
Interleukin-6 metabolism
Male
Matrix Metalloproteinase 9 metabolism
Microdialysis methods
Middle Aged
Neuroimaging
Oxygen metabolism
Subarachnoid Hemorrhage pathology
Subarachnoid Hemorrhage physiopathology
Treatment Outcome
Monitoring, Physiologic methods
Subarachnoid Hemorrhage metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1466-609X
- Volume :
- 19
- Database :
- MEDLINE
- Journal :
- Critical care (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 25887441
- Full Text :
- https://doi.org/10.1186/s13054-015-0809-9