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Hyperoxemia and Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage
Journal article   Open access   Peer reviewed

Hyperoxemia and Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Rebecca A Reynolds, Shaunak N Amin, Sumeeth V Jonathan, Alan R Tang, Matthews Lan, Chunxue Wang, Julie A Bastarache, Lorraine B Ware and Reid C Thompson
Neurocritical care, Vol.35(1), pp.30-38
08/01/2021
DOI: 10.1007/s12028-020-01136-6
PMCID: 8093321
PMID: 33150573
url
https://www.ncbi.nlm.nih.gov/pmc/articles/8093321View
Open Access

Abstract

Cerebral vasospasm is a major contributor to disability and mortality after aneurysmal subarachnoid hemorrhage. Oxidation of cell-free hemoglobin plays an integral role in neuroinflammation and is a suggested source of tissue injury after aneurysm rupture. This study sought to determine whether patients with subarachnoid hemorrhage and cerebral vasospasm were more likely to have been exposed to early hyperoxemia than those without vasospasm. This single-center retrospective cohort study included adult patients presenting with aneurysmal subarachnoid hemorrhage to Vanderbilt University Medical Center between January 2007 and December 2017. Patients with an ICD-9/10 diagnosis of aneurysmal subarachnoid hemorrhage were initially identified (N = 441) and subsequently excluded if they did not have intracranial imaging, arterial PaO values or died within 96 h post-rupture (N = 96). The final cohort was 345 subjects. The degree of hyperoxemia was defined by the highest PaO measured within 72 h after aneurysmal rupture. The primary outcome was development of cerebral vasospasm, which included asymptomatic vasospasm and delayed cerebral ischemia (DCI). Secondary outcomes were mortality and modified Rankin Scale. Three hundred and forty five patients met inclusion criteria; 218 patients (63%) developed vasospasm. Of those that developed vasospasm, 85 were diagnosed with delayed cerebral ischemia (DCI, 39%). The average patient age of the cohort was 55 ± 13 years, and 68% were female. Ninety percent presented with Fisher grade 3 or 4 hemorrhage (N = 310), while 42% presented as Hunt-Hess grade 4 or 5 (N = 146). In univariable analysis, patients exposed to higher levels of PaO by quintile of exposure had a higher mortality rate and were more likely to develop vasospasm in a dose-dependent fashion (P = 0.015 and P = 0.019, respectively). There were no statistically significant predictors that differentiated asymptomatic vasospasm from DCI and no significant difference in maximum PaO between these two groups. In multivariable analysis, early hyperoxemia was independently associated with vasospasm (OR = 1.15 per 50 mmHg increase in PaO2 [1.03, 1.28]; P = 0.013), but not mortality (OR = 1.10 [0.97, 1.25]; P = 0.147) following subarachnoid hemorrhage. Hyperoxemia within 72 h post-aneurysmal rupture is an independent predictor of cerebral vasospasm, but not mortality in subarachnoid hemorrhage. Hyperoxemia is a variable that can be readily controlled by adjusting the delivered FiO and may represent a modifiable risk factor for vasospasm.
 Adult Aneurysm, Ruptured Brain Ischemia Female Humans Infant, Newborn Retrospective Studies Subarachnoid Hemorrhage - complications Vasospasm, Intracranial - epidemiology Vasospasm, Intracranial - etiology

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