Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage
Background: Cerebral blood flow (CBF) is closely regulated by carbon dioxide (CO2). In patients with aneurysmal subarachnoid hemorrhage (aSAH), abnormal arterial partial pressure of CO2 (PaCO2) might deteriorate brain injuries. Nevertheless, the impact of dynamic PaCO2 fluctuations on neurological o...
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Elsevier
2024-10-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024152280 |
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| author | Rui Su Hong-Liang Li Yu-Mei Wang Linlin Zhang Jian-Xin Zhou |
| author_facet | Rui Su Hong-Liang Li Yu-Mei Wang Linlin Zhang Jian-Xin Zhou |
| author_sort | Rui Su |
| collection | DOAJ |
| description | Background: Cerebral blood flow (CBF) is closely regulated by carbon dioxide (CO2). In patients with aneurysmal subarachnoid hemorrhage (aSAH), abnormal arterial partial pressure of CO2 (PaCO2) might deteriorate brain injuries. Nevertheless, the impact of dynamic PaCO2 fluctuations on neurological outcomes in aSAH patients has not been extensively studied. Our study aimed to investigate the association between dynamic PaCO2 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)-PaCO2, an indicator representing the dynamic changes in PaCO2 levels. For the association between TWA-PaCO2 levels and unfavorable neurological outcomes in aSAH patients, multivariable logistic analysis was used to explore TWA-PaCO2 levels as categorical variables, and restricted cubic spline (RCS) was used to explore TWA-PaCO2 levels as continuous variables. Results: In multivariable logistic analysis, after adjusting confounders, when TWA-PaCO2 35–45 mmHg was as a reference, TWA-PaCO2 < 35 mmHg (odds ratio [OR] 2.15, 95 % confidence interval [CI] 0.83–5.55, P = 0.113) and TWA-PaCO2 > 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-PaCO2 levels and unfavorable neurological outcomes, with a nonlinear P-value of 0.023. The lowest ORs of unfavorable neurological outcomes were within PaCO2 32.8–38.1 mmHg. Conclusions: Both lower and higher PaCO2 levels are harmful to aSAH patients. PaCO2 in the range of 32.8–38.1 mmHg is associated with lowest unfavorable neurological outcomes. |
| format | Article |
| id | doaj-art-c57c4750e36a4f3c861b9f10e512950b |
| institution | Kabale University |
| issn | 2405-8440 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj-art-c57c4750e36a4f3c861b9f10e512950b2024-11-12T05:20:01ZengElsevierHeliyon2405-84402024-10-011020e39197Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhageRui Su0Hong-Liang Li1Yu-Mei Wang2Linlin Zhang3Jian-Xin Zhou4Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Corresponding author.Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Corresponding author.Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Clinical and Research Center on Acute Lung Injury, Emergency and Critical Care Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Corresponding author.Background: Cerebral blood flow (CBF) is closely regulated by carbon dioxide (CO2). In patients with aneurysmal subarachnoid hemorrhage (aSAH), abnormal arterial partial pressure of CO2 (PaCO2) might deteriorate brain injuries. Nevertheless, the impact of dynamic PaCO2 fluctuations on neurological outcomes in aSAH patients has not been extensively studied. Our study aimed to investigate the association between dynamic PaCO2 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)-PaCO2, an indicator representing the dynamic changes in PaCO2 levels. For the association between TWA-PaCO2 levels and unfavorable neurological outcomes in aSAH patients, multivariable logistic analysis was used to explore TWA-PaCO2 levels as categorical variables, and restricted cubic spline (RCS) was used to explore TWA-PaCO2 levels as continuous variables. Results: In multivariable logistic analysis, after adjusting confounders, when TWA-PaCO2 35–45 mmHg was as a reference, TWA-PaCO2 < 35 mmHg (odds ratio [OR] 2.15, 95 % confidence interval [CI] 0.83–5.55, P = 0.113) and TWA-PaCO2 > 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-PaCO2 levels and unfavorable neurological outcomes, with a nonlinear P-value of 0.023. The lowest ORs of unfavorable neurological outcomes were within PaCO2 32.8–38.1 mmHg. Conclusions: Both lower and higher PaCO2 levels are harmful to aSAH patients. PaCO2 in the range of 32.8–38.1 mmHg is associated with lowest unfavorable neurological outcomes.http://www.sciencedirect.com/science/article/pii/S2405844024152280Carbon dioxideAneurysmal subarachnoid hemorrhageNeurological outcomesRestricted cubic spline |
| spellingShingle | Rui Su Hong-Liang Li Yu-Mei Wang Linlin Zhang Jian-Xin Zhou Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage Heliyon Carbon dioxide Aneurysmal subarachnoid hemorrhage Neurological outcomes Restricted cubic spline |
| title | Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage |
| title_full | Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage |
| title_fullStr | Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage |
| title_full_unstemmed | Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage |
| title_short | Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage |
| title_sort | association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage |
| topic | Carbon dioxide Aneurysmal subarachnoid hemorrhage Neurological outcomes Restricted cubic spline |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024152280 |
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