The Impact of Intra-Arterial Papaverine-Hydrochloride on Cerebral Metabolism and Oxygenation for Treatment of Delayed-Onset Post-Subarachnoid Hemorrhage Vasospasm

Hosmann, Arthur; Wang, Wei-Te; Dodier, Philippe; Bavinzski, Gerhard; Engel, Adrian; Herta, Johannes; Plöchl, Walter; Reinprecht, Andrea; Gruber, Andreas

doi:10.1093/neuros/nyz500

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…The accuracy, sensitivity, and specificity of the XGBoost and logistic regression were calculated in Table 3. In the literature, there are studies that analyzed the data obtained to confirm the factors predicting a DCI [28][29][30][31]. A young age, aneurysm size, a large volume of SAH, poor neurologic grade on admission, smoking, HTN, and female gender were known as risk factors for vasospasm following aSAH [31,32].…”

Section: Performance Evaluation Using ML Modelingmentioning

confidence: 99%

Effect of Cilostazol on Delayed Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage Using Explainable Predictive Modeling

2023

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The studies interpreting DCI, a complication of SAH, and identifying correlations are very limited. This study aimed to investigate the effect of cilostazol on ACV and DCI after coil embolization for ruptured aneurysms (n = 432). A multivariate analysis was performed and explainable artificial intelligence approaches were used to analyze the contribution of cilostazol as a risk factor on the development of ACV and DCI with respect to global and local interpretation. The cilonimo group was significantly lower than the nimo group in ACV (13.5% vs. 29.3; p = 0.003) and DCI (7.9% vs. 20.7%; p = 0.006), respectively. In a multivariate logistic regression, the odds ratio for DCI for the cilonimo group, female sex, and aneurysm size was 0.556 (95% confidence interval (CI), 0.351–0.879; p = 0.012), 3.713 (95% CI, 1.683–8.191; p = 0.001), and 1.106 (95% CI, 1.008–1.214; p = 0.034). The risk of a DCI occurrence was significantly increased with an aneurysm size greater than 10 mm (max 80%). The mean AUC of the XGBoost and logistic regression models was 0.94 ± 0.03 and 0.95 ± 0.04, respectively. Cilostazol treatment combined with nimodipine could decrease the prevalence of ACV (13.5%) and DCI (7.9%) in patients with aSAH.

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Section: Performance Evaluation Using ML Modelingmentioning

confidence: 99%

Effect of Cilostazol on Delayed Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage Using Explainable Predictive Modeling

2023

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“…Intrahospital transport, head elevation/flat position 3 (Burnol et al, 2021;Dagod et al, 2021;Hosmann et al, 2021) Vasospasm therapy Nimodipine, endovascular therapy, papaverinehydrochloride 4 ( Hockel et al, 2016;Albanna et al, 2017;Hockel et al, 2017;Hosmann et al, 2020) Ventilation management Hyperoxia, hypercapnia, hypocapnia 10 ( Westermaier et al, 2016;Zhang et al, 2016;Ghosh et al, 2017;Sahoo et al, 2017;Brandi et al, 2019;Calviello et al, 2019;Svedung Wettervik et al, 2020b;Stetter et al, 2021;Gargadennec et al, 2022;Hosmann et al, 2022) b Other therapies Analgesia, hypothermia, enteral nutrition, decompressive craniectomy 4 ( Flynn et al, 2015;Kofler et al, 2018;Kovac et al, 2018;Ianosi et al, 2020) a One study included both cerebral intervention and MMM-guided treatment (mixed interventions Frontiers in Physiology frontiersin.org (Svedung Wettervik et al, 2019;Svedung Wettervik et al, 2020b;Svedung Wettervik et al, 2020a). The strength of a recycled study cohort is that it saves time and money; and could result in a broad understanding of the neuromonitoring signals.…”

Section: Physical (Movement) Interventionsmentioning

confidence: 99%

Cerebral multimodality monitoring in adult neurocritical care patients with acute brain injury: A narrative review

et al. 2022

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Cerebral multimodality monitoring (MMM) is, even with a general lack of Class I evidence, increasingly recognized as a tool to support clinical decision-making in the neuroscience intensive care unit (NICU). However, literature and guidelines have focused on unimodal signals in a specific form of acute brain injury. Integrating unimodal signals in multiple signal monitoring is the next step for clinical studies and patient care. As such, we aimed to investigate the recent application of MMM in studies of adult patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), acute ischemic stroke (AIS), and hypoxic ischemic brain injury following cardiac arrest (HIBI). We identified continuous or daily updated monitoring modalities and summarized the monitoring setting, study setting, and clinical characteristics. In addition, we discussed clinical outcome in intervention studies. We identified 112 MMM studies, including 11 modalities, over the last 7 years (2015–2022). Fifty-eight studies (52%) applied only two modalities. Most frequently combined were ICP monitoring (92 studies (82%)) together with PbtO2 (63 studies (56%). Most studies included patients with TBI (59 studies) or SAH (53 studies). The enrollment period of 34 studies (30%) took more than 5 years, whereas the median sample size was only 36 patients (q1- q3, 20–74). We classified studies as either observational (68 studies) or interventional (44 studies). The interventions were subclassified as systemic (24 studies), cerebral (10 studies), and interventions guided by MMM (11 studies). We identified 20 different systemic or cerebral interventions. Nine (9/11, 82%) of the MMM-guided studies included clinical outcome as an endpoint. In 78% (7/9) of these MMM-guided intervention studies, a significant improvement in outcome was demonstrated in favor of interventions guided by MMM. Clinical outcome may be improved with interventions guided by MMM. This strengthens the belief in this application, but further interdisciplinary collaborations are needed to overcome the heterogeneity, as illustrated in the present review. Future research should focus on increasing sample sizes, improved data collection, refining definitions of secondary injuries, and standardized interventions. Only then can we proceed with complex outcome studies with MMM-guided treatment.

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“…While the use of CMD has shown to improve functional outcomes, including the reduced mortality rate and better Glasgow coma scales 3-6 months post-injury, in patients with traumatic brain injury [15], the relationship between the CMD monitoring and clinical outcomes in SAH patients remain to be elucidated. Also, it has been reported that CMD may help to assess the efficacy of SAH-related interventions [54,57]. Furthermore, despite a recent article proposing the standard CMD reporting recommendations [61], a more comprehensive meta-analysis might be required for further standardizing the reporting of CMD results from both clinical and experimental studies due to the current variability in reported data of CMD in the literature.…”

Section: Clinical Application Of Cmd In Sahmentioning

confidence: 99%

Update: Microdialysis for Monitoring Cerebral Metabolic Dysfunction after Subarachnoid Hemorrhage

Spencer

Jiang

Liu

et al. 2020

JCM

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Cerebral metabolic dysfunction has been shown to extensively mediate the pathophysiology of brain injury after subarachnoid hemorrhage (SAH). The characterization of the alterations of metabolites in the brain can help elucidate pathophysiological changes occurring throughout SAH and the relationship between secondary brain injury and cerebral energy dysfunction after SAH. Cerebral microdialysis (CMD) is a tool that can measure concentrations of multiple bioenergetics metabolites in brain interstitial fluid. This review aims to provide an update on the implication of CMD on the measurement of metabolic dysfunction in the brain after SAH. A literature review was conducted through a general PubMed search with the terms “Subarachnoid Hemorrhage AND Microdialysis” as well as a more targeted search using MeSh with the search terms “Subarachnoid hemorrhage AND Microdialysis AND Metabolism.” Both experimental and clinical papers were reviewed. CMD is a suitable tool that has been used for monitoring cerebral metabolic changes in various types of brain injury. Clinically, CMD data have shown the dramatic changes in cerebral metabolism after SAH, including glucose depletion, enhanced glycolysis, and suppressed oxidative phosphorylation. Experimental studies using CMD have demonstrated a similar pattern of cerebral metabolic dysfunction after SAH. The combination of CMD and other monitoring tools has also shown value in further dissecting and distinguishing alterations in different metabolic pathways after brain injury. Despite the lack of a standard procedure as well as the presence of limitations regarding CMD application and data interpretation for both clinical and experimental studies, emerging investigations have suggested that CMD is an effective way to monitor the changes of cerebral metabolic dysfunction after SAH in real-time, and alternatively, the combination of CMD and other monitoring tools might be able to further understand the relationship between cerebral metabolic dysfunction and brain injury after SAH, determine the severity of brain injury and predict the pathological progression and outcomes after SAH. More translational preclinical investigations and clinical validation may help to optimize CMD as a powerful tool in critical care and personalized medicine for patients with SAH.

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The Impact of Intra-Arterial Papaverine-Hydrochloride on Cerebral Metabolism and Oxygenation for Treatment of Delayed-Onset Post-Subarachnoid Hemorrhage Vasospasm

Cited by 13 publications

References 37 publications

Effect of Cilostazol on Delayed Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage Using Explainable Predictive Modeling

Effect of Cilostazol on Delayed Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage Using Explainable Predictive Modeling

Cerebral multimodality monitoring in adult neurocritical care patients with acute brain injury: A narrative review

Update: Microdialysis for Monitoring Cerebral Metabolic Dysfunction after Subarachnoid Hemorrhage

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