Heart rate variability after endovascular coiling is associated with short-term outcomes in patients with subarachnoid hemorrhage

Cai, Kefu; Ni, Yaohui; Zhang, Yunfeng; Shen, Lihua; Ji, Qiuhong; Cao, Mei

doi:10.1080/01616412.2018.1493973

Cited by 12 publications

(14 citation statements)

References 30 publications

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“…In subarachnoid hemorrhage, more than 90% of patients exhibit abnormal electrocardiogram findings such as sinus bradycardia, sinus tachycardia, ST elevation, and QT prolongation [ 17 , 18 ]. Summarizing past data on heart rate, the average heart rate was 75–86 bpm, and approximately 20% of patients exhibit tachycardia of 100 bpm or more [ 13 , 19 , 20 ]. However, tachycardia of 130 bpm or more is rarely reported.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report

et al. 2023

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Background Subarachnoid hemorrhage and thyroid storm are similar in their clinical symptomatology, and diagnosis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent subarachnoid hemorrhage and thyroid storm we encountered at our hospital. Case presentation The patient was a 52-year-old woman. While bathing at home, the patient experienced a sudden disturbance of consciousness and was brought to our hospital. The main physical findings upon admittance were Glasgow Coma Scale score of E1V2M4, elevated blood pressure (208/145 mmHg), and tachycardia with atrial fibrillation (180 bpm) along with body temperature of 36.1 °C. Brain computed tomography revealed subarachnoid hemorrhage associated with a ruptured aneurysm of the posterior communicating artery branching from the left internal carotid artery, and aneurysm clipping was performed. Blood tests upon admission revealed high levels of free T3 and free T4 and low levels of thyroid-stimulating hormone. Upon determining that the patient had hyperthyroidism, thiamazole was administered. However, due to continuous impaired consciousness, fever, and persistence of tachycardia, the patient was diagnosed with thyroid storm. Oral potassium iodide and hydrocortisone were added to the treatment. The treatment was successful as the patient’s symptoms improved, and she became lucid. In this case, we believe that in the presence of untreated hyperthyroidism, the onset of subarachnoid hemorrhage induced thyroid storm. Tachycardia of 130 bpm or higher, which is the diagnostic criterion for thyroid storm, rarely occurs with subarachnoid hemorrhage. Therefore, we believe it is an important factor for recognizing the presence of the thyroid storm. In this case, clipping surgery was prioritized which resulted in a favorable outcome. However, it is possible that invasive surgery may have exacerbated thyroid storm, suggesting that treatment should be tailored as per patient’s condition. Conclusion If a pulse rate of 130 bpm or higher is observed alongside subarachnoid hemorrhage, we recommend considering the possibility of concomitant thyroid storm and testing for thyroid hormone. If concomitant thyroid storm is present, we believe that a treatment plan tailored to the patient’s condition is critical, and early diagnosis will lead to a favorable outcome for the patient.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report

et al. 2023

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“…Testing of ANS is a further cornerstone in prognostication of severely brain-injured patients. Several methods such as quantitative pupillometry [31] and heart rate variability [32] have been tested with promising results. Importantly, ES is a clinical routine procedure.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic response during endotracheal suctioning predicts awakening and functional outcome in subarachnoid hemorrhage patients

et al. 2020

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Background: Endotracheal suctioning (ES) provokes a cumulative hemodynamic response by activation of sympathetic and parasympathetic circuits in the central nervous system. In this proof-of-concept study, we aimed to analyze hemodynamic changes during ES in ventilated subarachnoid hemorrhage (SAH) patients and investigated whether the associated hemodynamic changes relate to the time to arousal and functional outcome. Methods: For the current observational study, 191 SAH patients admitted to the neurological intensive care unit of a tertiary hospital requiring mechanical ventilation were included. One thousand eighty ES episodes during the first 72 h of admission were analyzed. Baseline median heart rate (HR) and mean arterial pressure (MAP) were compared to peak HR and MAP during ES based on 5-min averaged data (ΔHR and ΔMAP). Multivariable analysis to assess associations between ΔHR and ΔMAP and time to arousal (time to Richmond Agitation Sedation Scale ≥ 0, RASS) and poor functional outcome (modified Rankin Scale Score > 2, mRS) was performed using generalized estimating equations. Results: Patients were 59 (IQR, 50-70) years old and presented with a median admission H&H grade of 4 (IQR, 3-5). Inhospital mortality was 22% (25% at 3 months) and median time to arousal was 13 (IQR, 4-21) days. HR increased by 2.3 ± 7.1 beats per minute (bpm) from 75.1 ± 14.8 bpm at baseline. MAP increased by 3.2 ± 7.8 mmHg from baseline 80.9 ± 9.8 mmHg. In multivariable analysis, ΔHR (p < 0.001) was significantly lower in patients who regained consciousness at a later time point and a lower ΔHR was associated with poor functional 3-month outcome independent of RASS (adjOR = 0.95; 95% CI = 0.93-0.98) or midazolam dose (adjOR = 0.96; 95% CI = 0.94-0.98). ΔMAP was neither associated with the time to regain consciousness (p = 0.087) nor with functional outcome (p = 0.263). Conclusion: Augmentation in heart rate may quantify the hemodynamic response during endotracheal suctioning in brain-injured patients. The value as a biomarker to early discriminate the time to arousal and functional outcome in acutely brain-injured patients needs prospective confirmation.

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“…One of the most popular scales used to assess the long-term outcome is modified Rankin scale (mRS). However, in our study, we focused on the early results of the treatment, thus GOS scale was more adequate to assess the outcome [36,37]. Nevertheless, other clinical scale to assess patients' long-term outcome needs to be applied in further research concerning relationship between the regional cerebral desaturation episodes and outcome in aSAH patients.…”

Section: Discussionmentioning

confidence: 99%

The relationship between the time of cerebral desaturation episodes and outcome in aneurysmal subarachnoid haemorrhage: a preliminary study

Burzyńska

Uryga

Kasprowicz

et al. 2019

J Clin Monit Comput

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In this preliminary study we investigated the relationship between the time of cerebral desaturation episodes (CDEs), the severity of the haemorrhage, and the short-term outcome in patients with aneurysmal subarachnoid haemorrhage (aSAH). Thirty eight patents diagnosed with aneurysmal subarachnoid haemorrhage were analysed in this study. Regional cerebral oxygenation (rSO 2) was assessed using near infrared spectroscopy (NIRS). A CDE was defined as rSO 2 < 60% with a duration of at least 30 min. The severity of the aSAH was assessed using the Hunt and Hess scale and the short-term outcome was evaluated utilizing the Glasgow Outcome Scale. CDEs were found in 44% of the group. The total time of the CDEs and the time of the longest CDE on the contralateral side were longer in patients with severe versus moderate aSAH [h:

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Heart rate variability after endovascular coiling is associated with short-term outcomes in patients with subarachnoid hemorrhage

Cited by 12 publications

References 30 publications

Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report

Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report

Hemodynamic response during endotracheal suctioning predicts awakening and functional outcome in subarachnoid hemorrhage patients

The relationship between the time of cerebral desaturation episodes and outcome in aneurysmal subarachnoid haemorrhage: a preliminary study

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