Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
Sci Rep. 2021 Aug 10;11(1):16235. doi: 10.1038/s41598-021-95602-6.
Brain hypoxia can occur after non-traumatic subarachnoid hemorrhage (SAH), even when levels of intracranial pressure (ICP) remain normal. Brain tissue oxygenation (PbtO) can be measured as a part of a neurological multimodal neuromonitoring. Low PbtO has been associated with poor neurologic recovery. There is scarce data on the impact of PbtO guided-therapy on patients' outcome. This single-center cohort study (June 2014-March 2020) included all patients admitted to the ICU after SAH who required multimodal monitoring. Patients with imminent brain death were excluded. Our primary goal was to assess the impact of PbtO-guided therapy on neurological outcome. Secondary outcome included the association of brain hypoxia with outcome. Of the 163 patients that underwent ICP monitoring, 62 were monitored with PbtO and 54 (87%) had at least one episode of brain hypoxia. In patients that required treatment based on neuromonitoring strategies, PbtO-guided therapy (OR 0.33 [CI 95% 0.12-0.89]) compared to ICP-guided therapy had a protective effect on neurological outcome at 6 months. In this cohort of SAH patients, PbtO-guided therapy might be associated with improved long-term neurological outcome, only when compared to ICP-guided therapy.
脑缺氧可发生于非创伤性蛛网膜下腔出血（SAH）后，即使颅内压（ICP）水平保持正常。脑组织氧合（PbtO）可作为神经多模态神经监测的一部分进行测量。低 PbtO 与神经功能恢复不良有关。关于 PbtO 指导治疗对患者预后的影响的数据很少。这项单中心队列研究（2014 年 6 月至 2020 年 3 月）纳入了所有因 SAH 入住 ICU 并需要多模态监测的患者。排除即将发生脑死亡的患者。我们的主要目标是评估 PbtO 指导治疗对神经结局的影响。次要结局包括脑缺氧与结局的关系。在接受 ICP 监测的 163 名患者中，有 62 名患者接受了 PbtO 监测，其中 54 名（87%）至少发生过一次脑缺氧。在根据神经监测策略需要治疗的患者中，与 ICP 指导治疗相比，PbtO 指导治疗（OR 0.33 [95%CI 0.12-0.89]）对 6 个月时的神经结局有保护作用。在本队列的 SAH 患者中，与 ICP 指导治疗相比，PbtO 指导治疗可能与改善长期神经结局相关。
