부산대학교 도서관

Introduction: Aneurysmal subarachnoid hemorrhage (SAH) accounts for 80% of non-traumatic SAH and has higher morbidity and mortality. Hyperoxia and hypocapnia are associated with poor outcomes in critically ill patients with brain injuries or post-cardiac arrest status. Yet, the impact of hyperoxia and hypocapnia on neurological outcome in patients with aneurysmal SAH has not been well studied. In this study, we aim to evaluate their impact on neurological outcome in patients with aneurysmal SAH. Methods: Patients with aneurysmal SAH admitted to Intensive Care Unit of a regional hospital in Hong Kong from January 2011 to December 2016 were included. Patients' demographics and comorbidities, clinical and radiological grading, blood gas, Glasgow Outcome Scale (GOS) at 3 months were recorded. Logistic regression analysis was performed to assess independent predictors for poor neurological outcome, i.e. GOS 1-3 at 3 months after initial insult. Results: Among 244 patients with aneurysmal SAH, 50% (122 patients) had poor neurological outcome. They were older, had higher APACHE IV score, WFNS grading and Fisher grading scale, and lower GCS on day 1 and were more likely to have intracranial or intraventricular hemorrhage (ICH or IVH). Hyperoxia (PaO2>200 mmHg) and hypocapnia (PaCO2 50 (OR 5.172, 95% CI 2.348-11.393, p 55 (OR 4.113, 95% CI 1.871-9.039, p 2 (OR 3.555, 95% CI 1.472-8.586, p=0.005), and WFNS grade >3 (OR 2.986, 95% CI 1.282-6.955, p=0.011) independently predicted poor neurological outcome at 3 months. Conclusion: Hyperoxia but not hypocapnia was associated with poor neurological outcomes at 3 months in patients with aneurysmal SAH.