naa a22 4500 510799507 CHVBK 20180411083348.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9890-6 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9890-6 Response of Brain Oxygen to Therapy Correlates with Long-Term Outcome After Subarachnoid Hemorrhage [Elektronische Daten] [Leif-Erik Bohman, Jared Pisapia, Matthew Sanborn, Suzanne Frangos, Elsa Lin, Monisha Kumar, Soojin Park, W. Kofke, Michael Stiefel, Peter LeRoux, Joshua Levine] Background: Brain oxygen (PbtO2) monitoring can help guide care of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients. The relationship between PbtO2-directed therapy and long-term outcome is unclear. We hypothesized that responsiveness to PbtO2-directed interventions is associated with outcome. Methods: Seventy-six aSAH patients who underwent PbtO2 monitoring were included. Long-term outcome [Glasgow Outcome Score-Extended (GOS-E) and modified Rankin Scale (mRS)] was ascertained using the social security death database and structured telephone interviews. Univariate and multivariate regression were used to identify variables that correlated with outcome. Results: Data from 64 patients were analyzed (12 were lost to follow-up). There were 530 episodes of compromised PbtO2 (<20mmHg) during a total of 7,174h of monitor time treated with 1,052 interventions. Forty-two patients (66%) survived to discharge. Median follow-up was 8.5months (range 0.1-87). At most recent follow-up 35 (55%) patients were alive, and 28 (44%) had a favorable outcome (mRS≤3). In multivariate ordinal regression analysis, only age and response to PbtO2-directed intervention correlated significantly with outcome. Increased age was associated with worse outcome (coeff. 0.8, 95% CI 0.3-1.3, p=0.003), and response to PbtO2-directed intervention was associated with improved outcome (coeff. −2.12, 95% CI −4.0 to −0.26, p=0.03). Patients with favorable outcomes had a 70% mean rate of response to PbtO2-directed interventions whereas patients with poor outcomes had a 45% response rate (p=0.005). Conclusions: Response to PbtO2-directed intervention is associated with improved long-term functional outcome in aSAH patients. Springer Science+Business Media New York, 2013 Brain tissue oxygen pressure nationallicence Brain hypoxia nationallicence Cerebral perfusion pressure nationallicence Outcome nationallicence Subarachnoid hemorrhage nationallicence Bohman Leif-Erik Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Pisapia Jared Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Sanborn Matthew Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Frangos Suzanne Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Lin Elsa Department of Neurology, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Kumar Monisha Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Park Soojin Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Kofke W. Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Stiefel Michael Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA aut LeRoux Peter Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA aut Levine Joshua Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 320-328 1541-6933 19:3<320 2013 19 12028 https://doi.org/10.1007/s12028-013-9890-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9890-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Bohman Leif-Erik Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Pisapia Jared Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Sanborn Matthew Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Frangos Suzanne Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Lin Elsa Department of Neurology, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Kumar Monisha Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Park Soojin Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Kofke W. Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Stiefel Michael Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA aut NATIONALLICENCE 700 1- LeRoux Peter Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Levine Joshua Department of Neurosurgery, Hospital of the University of Pennsylvania, 3 W Gates, 3400 Spruce Street, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 320-328 1541-6933 19:3<320 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer