Hypocapnia, ischemic lesions, and outcomes after intracerebral hemorrhage

An association between spontaneous hyperventilation, delayed cerebral ischemia, and poor clinical outcomes has been reported in subarachnoid hemorrhage. We evaluated the relationship between early pCO2 changes, ischemic lesions and outcomes in patients with intracerebral hemorrhage (ICH). Consecutiv...

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Published in:Journal of the neurological sciences 2020-11, Vol.418, p.117139-117139, Article 117139
Main Authors: Hextrum, Shannon, Minhas, Jatinder S., Liotta, Eric M., Sorond, Farzaneh A., Naidech, Andrew M., Maas, Matthew B.
Format: Article
Language:English
Subjects:
Cerebral Hemorrhage - complications
Cerebral Hemorrhage - diagnostic imaging
Cerebral Hemorrhage - epidemiology
Hospital Mortality
Humans
Hyperventilation
Hypocapnia
Hypocapnia - epidemiology
Intracerebral hemorrhage
Ischemia
Outcomes
Retrospective Studies
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Summary:An association between spontaneous hyperventilation, delayed cerebral ischemia, and poor clinical outcomes has been reported in subarachnoid hemorrhage. We evaluated the relationship between early pCO2 changes, ischemic lesions and outcomes in patients with intracerebral hemorrhage (ICH). Consecutive patients with spontaneous ICH were enrolled in an observational cohort study conducted between 2006 and 2019. Patient characteristics and discharge outcome were prospectively recorded. Arterial blood gas (ABG) measurements and mechanical ventilation settings in the first 72 h of admission were retrospectively collected. MRI images were adjudicated for diffusion-restricted lesions consistent with ischemia and distant from the hematoma. We examined the associations between pCO2 changes, ischemic lesions, and discharge outcomes by univariate and adjusted analyses. ABG data were available for 220 patients. Hyperventilation occurred in 52 (28%) cases and was not associated with clinical severity. Lower initial pCO2 was associated with greater risk of in-hospital death (OR 0.94 per mmHg, 95%CI [0.89, 0.996], p = 0.042) after adjustment for ICH Score, pneumonia and mechanical ventilation requirements. MRI data were available for 33 patients. Lower pCO2 was associated with a higher risk of ischemic lesions, except in patients with low initial systolic blood pressure (p 
ISSN:0022-510X
1878-5883
DOI:10.1016/j.jns.2020.117139