■动脉瘤性蛛网膜下腔出血(aSAH)通常需要长时间镇静以控制颅内压(ICP)升高并防止继发性脑损伤。在长时间镇静后中断镇静(IS)期间预测不良事件(AE)的最佳时机和生物标志物尚未建立。为了指导aSAH的镇静管理,我们的目标是探索频率,危险因素,以及aSAH中IS的结果。
■在一项回顾性队列研究中,共筛查了2015年1月至2020年4月的148例aSAH患者.总的来说,分析中包括30例患者,占42IS。IS期间的不良事件(AE)被用作核心结果指标,并分为神经系统和非神经系统AE。基线特征,IS之前的临床参数,AEs,使用健康记录收集功能结局.统计分析使用具有正则化的广义线性混合效应模型来识别候选预测因子,并随后进行引导以测试模型稳定性。作为探索性分析,采用多元线性和逻辑回归分析IS与重症监护病房住院时间的关系,机械通气的持续时间,和功能结果。
■平均年龄为56.9(SD14.8)岁,大多数患者表现为级别差的SAH(16/30,53.3%)。60.0%(18/30)的患者发生神经系统和非神经系统AE。定时,IS尝试次数,ICP负担,开颅手术状态,意识水平,心率,脑灌注压,氧饱和度,吸入氧气的分数,和温度被选为候选预测因子。通过引导,自疾病发作以来的经过时间(OR0.85,95%置信区间(95%CI)0.75-0.97),ICP负荷(OR1.24,95%CI1.02-1.52),颅骨切除术(OR0.68,95%CI0.48-0.69),和氧饱和度(或,0.800.72-0.89)被揭示为神经系统不良事件的相关生物标志物,而没有预先选择的预测因子与非神经系统AE密切相关。
■在aSAH中,明确停用镇静期间的并发症是常见的,但可以使用床边的临床参数进行预测.前瞻性多中心研究对于验证这些结果和进一步调查IS并发症的影响至关重要。
UNASSIGNED: Aneurysmal subarachnoid hemorrhage (aSAH) often necessitates prolonged sedation to manage elevated intracranial pressure (
ICP) and to prevent secondary brain injury. Optimal timing and biomarkers for predicting adverse events (AEs) during interruption of sedation (IS) after prolonged sedation are not well established. To guide sedation management in aSAH, we aimed to explore the frequency, risk factors, and outcomes of IS in aSAH.
UNASSIGNED: In a retrospective cohort study, a total of 148 patients with aSAH from January 2015 to April 2020 were screened. In total, 30 patients accounting for 42 IS were included in the analysis. Adverse events (AEs) during IS were used as core outcome measures and were categorized into neurological and non-neurological AEs. Baseline characteristics, clinical parameters before IS, AEs, and functional outcomes were collected using health records. Statistical analysis used generalized linear mixed-effects models with regularization to identify candidate predictors with subsequent bootstrapping to test model stability. As an exploratory analysis, multivariate linear and logistic regression was used to analyze the association between IS and intensive care unit length of stay, duration of mechanical ventilation, and functional outcomes.
UNASSIGNED: The mean age was 56.9 (SD 14.8) years, and a majority of the patients presented with poor-grade SAH (16/30, 53.3%). Neurological and non-neurological AEs occurred in 60.0% (18/30) of the patients. Timing, number of IS attempts,
ICP burden, craniectomy status, level of consciousness, heart rate, cerebral perfusion pressure, oxygen saturation, fraction of inspired oxygen, and temperature were selected as candidate predictors. Through bootstrapping, elapsed time since disease onset (OR 0.85, 95% confidence interval (95% CI) 0.75-0.97),
ICP burden (OR 1.24, 95% CI 1.02-1.52), craniectomy (OR 0.68, 95% CI 0.48-0.69), and oxygen saturation (OR, 0.80 0.72-0.89) were revealed as relevant biomarkers for neurological AEs, while none of the pre-selected predictors was robustly associated with non-neurological AEs.
UNASSIGNED: In aSAH, complications during the definite withdrawal of sedation are frequent but can potentially be predicted using clinical parameters available at the bedside. Prospective multicenter studies are essential to validate these results and further investigate the impact of IS complications.