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Minerva Anestesiologica 2023 January-February;89(1-2):96-103

DOI: 10.23736/S0375-9393.22.16468-0

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Brain tissue oxygenation monitoring in subarachnoid hemorrhage for the detection of delayed ischemia: a systematic review and meta-analysis

Camilla GELORMINI 1 , Anselmo CARICATO 2, Roberta PASTORINO 3, Daniele G. BIASUCCI 1, Eleonora IOANNONI 1, Nicola MONTANO 4, Eleonora STIVAL 1, Francesco SIGNORELLI 4, Isabella MELCHIONDA 1, Alessio ALBANESE 4, Enrico MARCHESE 4, Serena SILVA 1, Massimo ANTONELLI 5

1 Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; 2 Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy; 3 Department of Woman, Child, and Public Health, Gemelli University Hospital IRCCS, Rome, Italy; 4 Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy; 5 Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy



INTRODUCTION: Subarachnoid hemorrhage (SAH) is a severe subtype of stroke which can be caused by the rupture of an intracranial aneurysm. Following SAH, about 30% of patients develop a late neurologic deterioration due to a delayed cerebral ischemia (DCI). This is a metanalysis and systematic review on the association between values of brain tissue oxygenation (PbtO2) and DCI in patients with SAH.
EVIDENCE ACQUISITION: The protocol was written according to the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and approved by the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42021229338). Relevant literature published up to August 1, 2022 was systematically searched throughout the databases MEDLINE, WEB OF SCIENCE, SCOPUS. A systematic review and metanalysis was carried out. The studies considered eligible were those published in English; that enrolled adult patients (≥18years) admitted to neurointensive care units with aneurysmal SAH (aSAH); that reported presence of multimodality monitoring including PbtO2 and detection of DCI during the period of monitoring.
EVIDENCE SYNTHESIS: We founded 286 studies, of which six considered eligible. The cumulative mean of PbtO2was 19.5 mmHg in the ischemic group and 24.1mmHg in the non ischemic group. The overall mean difference of the values of PbtO2 between the patients with or without DCI resulted significantly different (-4.32 mmHg [IC 95%: -5.70, -2.94], without heterogeneity, I2 = 0%, and a test for overall effect with P<0.00001).
CONCLUSIONS: PbtO2 values were significantly lower in patients with DCI. Waiting for definitive results, monitoring of PbtO2 should be considered as a complementary parameter for multimodal monitoring of the risk of DCI in patients with SAH.


KEY WORDS: Subarachnoid hemorrhage; Vasospasm, intracranial; Brain ischemia

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