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- W4313232810 abstract "Introduction: Impaired autoregulation after aSAH may be associated with delayed cerebral ischemia (DCI), presumably due to a narrower mean arterial pressure (MAP) window with optimal cerebral perfusion (OptMAP). We assessed if deviation from cerebral oximetry-derived OptMAP targets is associated with DCI and mortality after aSAH. Methods: Autoregulation in aSAH patients was assessed using cerebral oximetry, initiated within 72 hours of neurocritical care admission. MAP was monitored using arterial line. Cerebral oximetry index (Cox), a moving correlation coefficient between MAP and regional cerebral oxygen saturation (rSO2), was calculated using ICM+ software. OptMAP, the MAP corresponding to lowest Cox value, was calculated for each 24-hour period. All patients received intensive DCI management per hospital aSAH protocol. DCI was defined as new neurological deficit with evidence of vasospasm (or vasospasm with CT perfusion deficit in comatose patients) and/or cerebral infarcts on delayed imaging, not related to aneurysm repair. Results: We monitored 30 aSAH patients (between 2014-2018) for a median duration of 3 (IQR, 2-4) days. Median World Federation of Neurological Surgeons (WFNS) grade was 4 (2-5), modified Fisher scale 4 (3-4), 90-day mortality 40%. DCI occurred in 15 (50%) patients, of whom only 12 developed cerebral infarction. Median OptMAP was 95 (80-112.5) mmHg. Patients with DCI, had greater median difference (5 vs 0.5mmHg; p=0.08) and peak difference (16 vs 6mmHg; p=0.001) between Opt and observed MAP (OptMAP-ObsMAP). %Time spent below OptMAP was higher in patients that developed DCI-related cerebral infarcts (37 vs 22%;p=0.04). In models adjusted for age/WFNS, peak difference between Opt and ObsMAP (aOR per mmHg, 1.3[1.04-1.6]) was associated with DCI, while %Time spent below OptMAP (per10%, 1.7[1.03-2.9]) with DCI-related cerebral infarction. In cox regression, >5mmHg difference between Opt and ObsMAP (HR, 4.5[1.3-15.5]), and >25% time spent below OptMAP were associated with 90-day mortality (3.9[1.1-13.5]). Conclusions: Deviation from cerebral oximetry-derived OptMAP and time spent below OptMAP were associated with DCI and mortality after aSAH in this pilot study. Individualisation of MAP targets using non-invasive cerebral oximetry warrants further evaluation in a larger prospective cohort." @default.
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- W4313232810 date "2022-12-15" @default.
- W4313232810 modified "2023-09-27" @default.
- W4313232810 title "532: CEREBRAL OXIMETRY-DERIVED OPTIMAL BLOOD PRESSURE TARGETS IN ANEURYSMAL SUBARACHNOID HEMORRHAGE" @default.
- W4313232810 doi "https://doi.org/10.1097/01.ccm.0000907856.11552.9f" @default.
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