Respiratory and Swallowing Outcomes Based on Aneurysm Location in 360 Patients with Subarachnoid Hemorrhage

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) may result in abnormal respiratory and swallowing function. We analyzed factors that may influence long-term respiratory and swallowing function in aSAH patients and compared patients with anterior and posterior aneurysm locations. We retrospectively reviewed 360 consecutive aSAH patients. We recorded location of the aneurysm and respiratory indices on admission, in-hospital adverse respiratory events, and the need for tracheostomy (for respiratory failure) or percutaneous endoscopic gastrostomy (PEG) tube (for prolonged dysphagia). Respiratory and swallowing function was also reviewed at 1 year and at most recent clinical follow-up. Aneurysms consisted of 293 described as anterior circulation (81.4%) and 67 described as posterior circulation (18.6%), including 31 patients with basilar artery aneurysms and 16 with posterior inferior cerebellar artery (PICA) aneurysms. There were no differences in oxygen saturation or PaO2:FiO2 ratio on admission, though patients with PICA aneurysms presented significantly more commonly with endotracheal intubation. PICA aneurysm patients had higher rates of tracheostomy and PEG tube dependence at 1 year in univariate analysis. Higher Hunt-Hess grade was a predictor of pneumonia and prolonged intubation, whereas older age and prolonged hospitalization were predictors of PEG placement in multivariate analysis. Ruptured anterior and posterior circulation aneurysms have similar rates of in-hospital respiratory and swallowing dysfunction. There was a higher rate of swallowing dysfunction in the posterior circulation aneurysm group compared with the anterior group at most recent follow-up (12% vs. 2%, P= 0.035). Patients with PICA aneurysms demonstrated higher rates of tracheostomy and PEG, though the latter did not achieve statistical significance.