Khalil M Yousef1, Jeffrey R Balzer2, Elizabeth A Crago3, Samuel M Poloyac4, Paula R Sherwood5. 1. University of Jordan, Faculty of Nursing, Queen Rania Al Abdullah Street, Amman 11942, Jordan. Electronic address: K.yousef@ju.edu.jo. 2. Neurological Surgery Department, University of Pittsburgh Medical Center-Presbyterian, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA. 3. University of Pittsburgh, School of Nursing Acute and Tertiary Care, 320B Victoria Building, 3500 Victoria St., Pittsburgh, PA 15261, USA. 4. University of Pittsburgh, School of Pharmacy, 807 Salk Hall, Pittsburgh, PA 15213, USA. 5. Acute and Tertiary Care Department, School of Nursing, Department of Neurological Surgery, School of Medicine, University of Pittsburgh, 336 Victoria Building, 3500 Victoria St., Pittsburgh, PA 15261, USA; University of Pittsburgh, School of Nursing Acute and Tertiary Care, 320B Victoria Building, 3500 Victoria St., Pittsburgh, PA 15261, USA.
Abstract
OBJECTIVES: To examine the relationship between regional cerebral oxygen saturation (rSO2), delayed cerebral ischaemia (DCI), and outcomes after aneurysmal subarachnoid haemorrhage (aSAH). RESEARCH METHODOLOGY: Subjects (n = 163) with aSAH, age 21-75 years, and Fisher grade >1 were included in the study. Continuous rSO2 monitoring was performed for 5-10 days after injury using near-infrared spectroscopy with sensors over the frontal/temporal cortex. rSO2<50 indicated desaturation. DCI was defined as neurological deterioration due to impaired cerebral blood flow. Three- and 12-month functional outcomes were assessed by the modified Rankin scale (MRS) as good (0-3) and poor (4-6). RESULTS: DCI occurred in 57% of patients; of these 66% had rSO2<50. Overall, 56% had rSO2<50 on either side, 21% and 16% had poor MRS at 3 and 12 months. Subjects with rSO2 <50 were 3.25 times more likely to have DCI compared to those with rSO2 >50 (OR 3.25, 95%CI 1.58-6.69), positive predictive value (PPV) = 70%. Subjects with rSO2 <50 were 2.7 times more likely to have poor 3-month MRS compared to those with rSO2 >50 (OR 2.7, 95%CI 1.1-7.2), PPV = 70%. CONCLUSIONS: These results suggest that NIRS has the potential for detecting DCI after aSAH. This potential needs to be further explored in a larger prospective study.
OBJECTIVES: To examine the relationship between regional cerebral oxygen saturation (rSO2), delayed cerebral ischaemia (DCI), and outcomes after aneurysmal subarachnoid haemorrhage (aSAH). RESEARCH METHODOLOGY: Subjects (n = 163) with aSAH, age 21-75 years, and Fisher grade >1 were included in the study. Continuous rSO2 monitoring was performed for 5-10 days after injury using near-infrared spectroscopy with sensors over the frontal/temporal cortex. rSO2<50 indicated desaturation. DCI was defined as neurological deterioration due to impaired cerebral blood flow. Three- and 12-month functional outcomes were assessed by the modified Rankin scale (MRS) as good (0-3) and poor (4-6). RESULTS:DCI occurred in 57% of patients; of these 66% had rSO2<50. Overall, 56% had rSO2<50 on either side, 21% and 16% had poor MRS at 3 and 12 months. Subjects with rSO2 <50 were 3.25 times more likely to have DCI compared to those with rSO2 >50 (OR 3.25, 95%CI 1.58-6.69), positive predictive value (PPV) = 70%. Subjects with rSO2 <50 were 2.7 times more likely to have poor 3-month MRS compared to those with rSO2 >50 (OR 2.7, 95%CI 1.1-7.2), PPV = 70%. CONCLUSIONS: These results suggest that NIRS has the potential for detecting DCI after aSAH. This potential needs to be further explored in a larger prospective study.
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