Neuroanesthesia & neurocritical care
The metabolic and autoregulatory profile of reversible delayed cerebral ischemia in unconscious patients after aneurysmal subarachnoid hemorrhage: a prospective multimodal neuromonitoring cohort study
Authors' conclusion
Loss of cerebrovascular reactivity and metabolic disturbances precede cerebral hypoperfusion in SAH. Lower PRx and LPR levels are independently associated with improved DCI treatment efficacy.
Study context
- Population
- Unconscious (neurologically unassessable) patients with aneurysmal subarachnoid hemorrhage (SAH) and neuromonitoring (intracranial pressure (ICP), PtiO2 and/or cerebral microdialysis)126 (47%) neuromonitored
- Participants
- 268 participants
- Exposure
- Perfusion deficits progressing to infarction vs reversed by treatment
- Infarctionn = 24
- Reversedn = 39reference
- Outcome
- Factors associated with delayed cerebral ischemia (DCI)-related infarction (CT imaging at discharge)
Methodological detailsmultimodal neuromonitoring, consecutive patients
- Multimodal neuromonitoring
- Consecutive patients
Main finding
As reported in the abstract
Factors associated with treatment response and reduced infarction risk (GLMM)
Odds ratio (95% CI)P value
Lower PRx
2.70(1.04–4.67)
P < 0.001Lower LPR
1.02(1.01–1.03)
P < 0.001Observational data: associations, not effects.
Further findings
CTP deficits
- CTP deficits identified
- 72 (57%)
- Neuromonitoring probes near affected areas
- 63 (88%)
Functional outcome (modified rankin scale (mRS)) · 12 months
- Pooled PRx and LPR not associated with functional outcome
Original publication
The metabolic and autoregulatory profile of reversible delayed cerebral ischemia in unconscious patients after aneurysmal subarachnoid hemorrhage: a prospective multimodal neuromonitoring cohort study. Crit Care. Published 5 June 2025. doi:10.
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