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Precise Clinical Outcome in High-Grade Aneurysmal Subarachnoid Hemorrhage: Brain Oxygenation Matters!

By Johan Schmitt, Philippe Aries, Marc Danguy Des Deserts & Christophe Giacardi
First Online: 27 April 2021

Wettervik et al. [1] recently published a great work titled “Temporal Dynamics of ICP, CPP, PRx, and CPPopt in High-Grade Aneurysmal Subarachnoid Hemorrhage and the Relation to Clinical Outcome.” We read with interest and would like to address some comments.
First, the treatment protocol is questionable. An important data point is not provided by the authors: partial pressure of arterial carbon dioxide. On the basis of this retrospective study, results could be biased when excluding this major parameter. Indeed, hypocapnia is now well known as leading to worse outcome in neurocritically ill patients, including those with aneurysmal subarachnoid hemorrhage (aSAH) [2]. Concerning unconscious patients with a motor Glasgow score below 6, providing sedation for all could also blind neurological assessment and guide these different treatments.

Read the full article here.