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Neurocritical Care
Published in: Neurocritical Care 3/2015

01-12-2015 | Original Article

The Association Between Spontaneous Hyperventilation, Delayed Cerebral Ischemia, and Poor Neurological Outcome in Patients with Subarachnoid Hemorrhage

Authors: Craig A. Williamson, Kyle M. Sheehan, Renuka Tipirneni, Christopher D. Roark, Aditya S. Pandey, B. Gregory Thompson, Venkatakrishna Rajajee

Published in: Neurocritical Care | Issue 3/2015

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Abstract

Background

The frequency and associations of spontaneous hyperventilation in subarachnoid hemorrhage (SAH) are unknown. Because hyperventilation decreases cerebral blood flow, it may exacerbate delayed cerebral ischemia (DCI) and worsen neurological outcome.

Methods

This is a retrospective analysis of data from a prospectively collected cohort of SAH patients at an academic medical center. Spontaneous hyperventilation was defined by PaCO2 <35 mmHg and pH >7.45 and subdivided into moderate and severe groups. Clinical and demographic characteristics of patients with and without spontaneous hyperventilation were compared using χ 2 or t tests. Bivariate and multivariable logistic regression analyses were conducted to examine the association of moderate and severe hyperventilation with DCI and discharge neurological outcome.

Results

Of 207 patients, 113 (55 %) had spontaneous hyperventilation. Spontaneously hyperventilating patients had greater illness severity as measured by the Hunt–Hess, World Federation of Neurosurgical Societies (WFNS), and SAH sum scores. They were also more likely to develop the following complications: pneumonia, neurogenic myocardial injury, systemic inflammatory response syndrome (SIRS), radiographic vasospasm, DCI, and poor neurological outcome. In a multivariable logistic regression model including age, gender, WFNS, SAH sum score, pneumonia, neurogenic myocardial injury, etiology, and SIRS, only moderate [odds ratio (OR) 2.49, 95 % confidence interval (CI) 1.10–5.62] and severe (OR 3.12, 95 % CI 1.30–7.49) spontaneous hyperventilation were associated with DCI. Severe spontaneous hyperventilation (OR 4.52, 95 % CI 1.37–14.89) was also significantly associated with poor discharge outcome in multivariable logistic regression analysis.

Conclusion

Spontaneous hyperventilation is common in SAH and is associated with DCI and poor neurological outcome.
Appendix
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Metadata
Title
The Association Between Spontaneous Hyperventilation, Delayed Cerebral Ischemia, and Poor Neurological Outcome in Patients with Subarachnoid Hemorrhage
Authors
Craig A. Williamson
Kyle M. Sheehan
Renuka Tipirneni
Christopher D. Roark
Aditya S. Pandey
B. Gregory Thompson
Venkatakrishna Rajajee
Publication date
01-12-2015
Publisher
Springer US
Published in
Neurocritical Care / Issue 3/2015
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-015-0138-5

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