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Published on: January 17, 2013
Cerebral perfusion pressure threshold to prevent delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage
Jiawei Cai1, Wenhua Fang1, Fuxiang Chen2
1Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China.
Insights
Maintaining cerebral perfusion pressure (CPP) above 70 mmHg may help prevent delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). This study identified CPP thresholds predictive of DCI, suggesting a target for improved patient outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) is a critical condition often leading to delayed cerebral ischemia (DCI).
- Cerebral perfusion pressure (CPP) monitoring is crucial for managing patients post-aSAH.
- Identifying optimal CPP thresholds is essential for reducing DCI incidence and improving patient prognosis.
Purpose of the Study:
- To determine a specific cerebral perfusion pressure (CPP) threshold that can effectively minimize the occurrence of delayed cerebral ischemia (DCI) in patients following aneurysmal subarachnoid hemorrhage (aSAH).
- To establish a predictive model for DCI risk based on CPP monitoring data.
Main Methods:
- Analysis of clinical data from 60 patients with aSAH who underwent CPP monitoring.
- Calculation of the total time ratio of CPP below predefined thresholds (50-80 mmHg).
- Binary logistic regression and ROC curve analysis to correlate CPP time ratios with DCI and identify cutoff values.
Main Results:
- CPP time ratios below 50, 60, and 70 mmHg were identified as significant predictors of DCI.
- Cutoff time ratios for DCI risk were 0.4% (AUC=0.777) for <50 mmHg, 7.0% (AUC=0.702) for <60 mmHg, and 28.7% (AUC=0.696) for <70 mmHg.
- CPP levels <80 mmHg were not significantly related to DCI, and DCI patients had worse 3-month outcomes.
Conclusions:
- A positive relationship exists between higher CPP thresholds and reduced risk of DCI.
- Maintaining CPP above 70 mmHg may be a beneficial strategy for preventing DCI after aSAH.
- Further research is warranted to confirm the efficacy of this CPP threshold in clinical practice.
Objective:
To seek a cerebral perfusion pressure (CPP) threshold that can reduce the occurrence of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH).
Methods:
We analyzed the clinical data of patients with the diagnosis of aSAH and underwent CPP monitoring in our department from February 2014 to December 2015. CPP was divided into four specified thresholds by every 10 mmHg increments, which were from 50 mmHg to 80 mmHg. The totally time ratio of CPP below each threshold was calculated. The correlation between the time ratio and DCI were analyzed using binary logistic regression. And receiver operating characteristic curve was performed to identify the cutoff time ratios at higher risk of DCI.
Results:
Finally, 17 patients developed DCI from 60 patients who were recruited. The time ratios of CPP which was below 50 mmHg, 60 mmHg and 70 mmHg were found predictors of DCI by the binary logistic regression. The cutoff time ratios were 0.4% (AUC = 0.777), 7.0% (AUC = 0.702), 28.7% (AUC = 0.696) respectively. While at the level of 80 mmHg, the cutoff time ratio was 65% (AUC = 0.595). It was not related to DCI (P = 0.167). Patients suffered from DCI had a worse outcome than who did not at 3 month after aSAH (P = 0.018).
Conclusion:
Time ratios at higher risk of DCI had a positive relationship with the CPP thresholds. Keeping CPP above 70 mmHg may be helpful to prevent DCI after aSAH, but it still needs further investigation.
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