Work

Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage

Year: 2024

Type: article

Abstract: Background Cerebral blood flow (CBF) is closely regulated by carbon dioxide (CO 2 ). In patients with aneurysmal subarachnoid hemorrhage (aSAH), abnormal arterial partial pressure of CO 2 (PaCO 2 ) might deteriorate brain injuries. Nevertheless, the impact of dynamic PaCO 2 fluctuations on neurological outcomes in aSAH patients has not been extensively studied. Our study aimed to investigate the association between dynamic PaCO 2 levels and unfavorable neurological outcomes in aSAH patients. Methods In this retrospective observational study, we consecutively enrolled 159 aSAH patients from December 2019 to July 2021. Arterial blood gas measurements within 10 days after intensive care unit (ICU) admission for each patient were recorded to calculate the time-weighted average (TWA)-PaCO 2 , an indicator representing the dynamic changes in PaCO 2 levels. For the association between TWA-PaCO 2 levels and unfavorable neurological outcomes in aSAH patients, multivariable logistic analysis was used to explore TWA-PaCO 2 levels as categorical variables, and restricted cubic spline (RCS) was used to explore TWA-PaCO 2 levels as continuous variables. Results In multivariable logistic analysis, after adjusting confounders, when TWA-PaCO 2 35–45 mmHg was as a reference, TWA-PaCO 2 < 35 mmHg (odds ratio [OR] 2.15, 95 % confidence interval [CI] 0.83–5.55, P = 0.113) and TWA-PaCO 2 > 45 mmHg (OR 8.31, 95 % CI 0.72–96.14, P = 0.090) were not independently associated with unfavorable neurological outcomes (modified Rankin score of 3–6). The RCS shows a "U" shape curve between TWA-PaCO 2 levels and unfavorable neurological outcomes, with a nonlinear P - value of 0.023. The lowest ORs of unfavorable neurological outcomes were within PaCO 2 32.8–38.1 mmHg. Conclusions Both lower and higher PaCO 2 levels are harmful to aSAH patients. PaCO 2 in the range of 32.8–38.1 mmHg is associated with lowest unfavorable neurological outcomes.

Source: Heliyon

DOI: 10.1016/j.heliyon.2024.e39197

Authors: Rui Su, Hong-Liang Li, Yu-Mei Wang, Linlin Zhang, Jian-Xin Zhou

Institutions: Capital Medical University, Beijing Tian Tan Hospital, Beijing Shijitan Hospital

Language: English

Topic: Intracranial Aneurysms: Treatment and Complications

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,100