Monitoring of Cerebrovascular Reactivity in Intracerebral Hemorrhage and Its Relation with Survival.

Abstract

Neuromonitoring analysis for intracerebral hemorrhage (ICH) is still rare, especially regarding vascular reactivity patterns. Our goal was to analyze neuromonitoring data and 28-day mortality for ICH patients. Neuromonitoring records were retrospectively reviewed from a cohort of ICH patients admitted to a neurocritical care unit between 2013 and 2016. Variables considered were intracranial pressure (ICP), cerebral perfusion pressure (CPP), optimal CPP, and pressure reactivity index (PRx), as well as ICP dose, PRx dose, and time percentage above critical value (T%abv). Information regarding demographics, surgical drainage, external ventricular drain placement, and 28-day mortality was recorded. Statistical analysis was performed using the t-test and Kaplan-Meier curves. Forty-six patients were analyzed, with a mean of 263±173h of signal records and a median length of stay in the intensive care unit of 22 (interquartile range of 13) days. The mean age was 62.6±11.8years old, and 24 (52%) of the patients were male. Patients who died within 28day (37.0%) had significantly higher mean ICP, PRx, ICP dose, PRx dose, and T%abv. Although their mean ICP was under 20mmHg, they presented PRx>0.25, indicating impaired cerebrovascular reactivity (0.30±0.26). Also, patients with PRx>0.25 had a lower survival rate, with a proportion of 14% at 28days, as opposed to 85% of those with PRx<0.25 (p<0.001). The data suggest that autoregulation indexes are associated with 28-day mortality for ICH patients.