Abstract
Objectives: This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid hemorrhage are evaluated. Design: A study of medical complications observed in the placebo limb of a large, randomized, controlled trial of the calcium antagonist, nicardipine, after subarachnoid hemorrhage. Setting: Patients were recruited from 50 hospitals in 41 neurosurgical centers in the United States and Canada. Patients: A total of 457 patients with subarachnoid hemorrhage, ≥18 yrs of age, were randomly assigned to the placebo group. All patients arrived at the participating center within 7 days (mean 1.0 ± 1.8 [SD] days) of rupture of an angiographically documented saccular aneurysm. Measurements and Main Results: The frequency rates of symptomatic vasospasm, rebleeding, and total mortality rate after subarachnoid hemorrhage at 3-month follow-up were 46%, 7%, and 19%, respectively. The frequency of having at least one severe (life- threatening) medical complication was 40%. The proportion of deaths from medical complications was 23%. This value was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19%), rebleeding (22%), and vasospasm (23%) after aneurysmal rupture. The frequency of life-threatening cardiac arrhythmias was 5%; less ominous rhythm disturbances occurred in 30% of the patients. There was an increased frequency of cardiac arrhythmias on the day of, or day after, aneurysm surgery. Pulmonary edema occurred in 23% of the patients, with a 6% occurrence rate incidence of severe pulmonary edema. There was a wide variation from center to center, with the greatest frequency on days 3 through 7. There was a nonsignificant association of pulmonary edema with the use of hypertensive hypervolemic therapy (p = .10), and a significant association with the timing of surgery (p < .05). Some degree of hepatic dysfunction was noted in 24% of patients, the majority with only mild abnormalities of hepatic enzymes with no clinical accompaniment (4% frequency of severe hepatic dysfunction). Thrombocytopenia occurred in 4% of patients, usually in the setting of sepsis. Renal dysfunction was reported in 7% of the patients, with 15% of that figure deemed to be of life-threatening severity. There was an association (p = .001) with antibiotic therapy. Conclusions: Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding, or vasospasm individually. Pulmonary complications are the most common nonneurologic cause of death. Cardiac arrhythmia, although frequent, was not associated with significant mortality. The frequency of cardiac arrhythmia and pulmonary edema increased on the day of, or day after, aneurysm surgery. Renal and hepatic dysfunction, and blood dyscrasias, were also observed, underscoring the need for meticulous monitoring for metabolic and hematologic derangements.
| Original language | English |
|---|---|
| Pages (from-to) | 1007-1017 |
| Number of pages | 11 |
| Journal | Critical Care Medicine |
| Volume | 23 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 26 1995 |
| Externally published | Yes |
Fingerprint
Keywords
- arrhythmia
- cerebral aneurysm
- cerebral ischemia, transient
- critical care
- kidney disease
- liver disease
- pulmonary edema
- subarachnoid hemorrhage
- thrombocytopenia
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
Medical complications of aneurysmal subarachnoid hemorrhage : A report of the multicenter, cooperative aneurysm study. / Solenski, N. J.; Haley, E. C.; Kassell, N. F.; Kongable, G.; Germanson, T.; Truskowski, L.; Torner, J. C.; Spetzler, R. F.; Selman, W. R.; Warf, B.; Barnett, G. H.; Solomon, R. A.; Friedman, A. H.; Campbell, R. L.; Horner, T.; Nauta, H. J.; Heros, Roberto; Muizelaar, J. P.; Mohr, G.
In: Critical Care Medicine, Vol. 23, No. 6, 26.06.1995, p. 1007-1017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Medical complications of aneurysmal subarachnoid hemorrhage
T2 - A report of the multicenter, cooperative aneurysm study
AU - Solenski, N. J.
AU - Haley, E. C.
AU - Kassell, N. F.
AU - Kongable, G.
AU - Germanson, T.
AU - Truskowski, L.
AU - Torner, J. C.
AU - Spetzler, R. F.
AU - Selman, W. R.
AU - Warf, B.
AU - Barnett, G. H.
AU - Solomon, R. A.
AU - Friedman, A. H.
AU - Campbell, R. L.
AU - Horner, T.
AU - Nauta, H. J.
AU - Heros, Roberto
AU - Muizelaar, J. P.
AU - Mohr, G.
PY - 1995/6/26
Y1 - 1995/6/26
N2 - Objectives: This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid hemorrhage are evaluated. Design: A study of medical complications observed in the placebo limb of a large, randomized, controlled trial of the calcium antagonist, nicardipine, after subarachnoid hemorrhage. Setting: Patients were recruited from 50 hospitals in 41 neurosurgical centers in the United States and Canada. Patients: A total of 457 patients with subarachnoid hemorrhage, ≥18 yrs of age, were randomly assigned to the placebo group. All patients arrived at the participating center within 7 days (mean 1.0 ± 1.8 [SD] days) of rupture of an angiographically documented saccular aneurysm. Measurements and Main Results: The frequency rates of symptomatic vasospasm, rebleeding, and total mortality rate after subarachnoid hemorrhage at 3-month follow-up were 46%, 7%, and 19%, respectively. The frequency of having at least one severe (life- threatening) medical complication was 40%. The proportion of deaths from medical complications was 23%. This value was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19%), rebleeding (22%), and vasospasm (23%) after aneurysmal rupture. The frequency of life-threatening cardiac arrhythmias was 5%; less ominous rhythm disturbances occurred in 30% of the patients. There was an increased frequency of cardiac arrhythmias on the day of, or day after, aneurysm surgery. Pulmonary edema occurred in 23% of the patients, with a 6% occurrence rate incidence of severe pulmonary edema. There was a wide variation from center to center, with the greatest frequency on days 3 through 7. There was a nonsignificant association of pulmonary edema with the use of hypertensive hypervolemic therapy (p = .10), and a significant association with the timing of surgery (p < .05). Some degree of hepatic dysfunction was noted in 24% of patients, the majority with only mild abnormalities of hepatic enzymes with no clinical accompaniment (4% frequency of severe hepatic dysfunction). Thrombocytopenia occurred in 4% of patients, usually in the setting of sepsis. Renal dysfunction was reported in 7% of the patients, with 15% of that figure deemed to be of life-threatening severity. There was an association (p = .001) with antibiotic therapy. Conclusions: Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding, or vasospasm individually. Pulmonary complications are the most common nonneurologic cause of death. Cardiac arrhythmia, although frequent, was not associated with significant mortality. The frequency of cardiac arrhythmia and pulmonary edema increased on the day of, or day after, aneurysm surgery. Renal and hepatic dysfunction, and blood dyscrasias, were also observed, underscoring the need for meticulous monitoring for metabolic and hematologic derangements.
AB - Objectives: This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid hemorrhage are evaluated. Design: A study of medical complications observed in the placebo limb of a large, randomized, controlled trial of the calcium antagonist, nicardipine, after subarachnoid hemorrhage. Setting: Patients were recruited from 50 hospitals in 41 neurosurgical centers in the United States and Canada. Patients: A total of 457 patients with subarachnoid hemorrhage, ≥18 yrs of age, were randomly assigned to the placebo group. All patients arrived at the participating center within 7 days (mean 1.0 ± 1.8 [SD] days) of rupture of an angiographically documented saccular aneurysm. Measurements and Main Results: The frequency rates of symptomatic vasospasm, rebleeding, and total mortality rate after subarachnoid hemorrhage at 3-month follow-up were 46%, 7%, and 19%, respectively. The frequency of having at least one severe (life- threatening) medical complication was 40%. The proportion of deaths from medical complications was 23%. This value was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19%), rebleeding (22%), and vasospasm (23%) after aneurysmal rupture. The frequency of life-threatening cardiac arrhythmias was 5%; less ominous rhythm disturbances occurred in 30% of the patients. There was an increased frequency of cardiac arrhythmias on the day of, or day after, aneurysm surgery. Pulmonary edema occurred in 23% of the patients, with a 6% occurrence rate incidence of severe pulmonary edema. There was a wide variation from center to center, with the greatest frequency on days 3 through 7. There was a nonsignificant association of pulmonary edema with the use of hypertensive hypervolemic therapy (p = .10), and a significant association with the timing of surgery (p < .05). Some degree of hepatic dysfunction was noted in 24% of patients, the majority with only mild abnormalities of hepatic enzymes with no clinical accompaniment (4% frequency of severe hepatic dysfunction). Thrombocytopenia occurred in 4% of patients, usually in the setting of sepsis. Renal dysfunction was reported in 7% of the patients, with 15% of that figure deemed to be of life-threatening severity. There was an association (p = .001) with antibiotic therapy. Conclusions: Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding, or vasospasm individually. Pulmonary complications are the most common nonneurologic cause of death. Cardiac arrhythmia, although frequent, was not associated with significant mortality. The frequency of cardiac arrhythmia and pulmonary edema increased on the day of, or day after, aneurysm surgery. Renal and hepatic dysfunction, and blood dyscrasias, were also observed, underscoring the need for meticulous monitoring for metabolic and hematologic derangements.
KW - arrhythmia
KW - cerebral aneurysm
KW - cerebral ischemia, transient
KW - critical care
KW - kidney disease
KW - liver disease
KW - pulmonary edema
KW - subarachnoid hemorrhage
KW - thrombocytopenia
UR - http://www.scopus.com/inward/record.url?scp=0029061064&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0029061064&partnerID=8YFLogxK
U2 - 10.1097/00003246-199506000-00004
DO - 10.1097/00003246-199506000-00004
M3 - Article
C2 - 7774210
AN - SCOPUS:0029061064
VL - 23
SP - 1007
EP - 1017
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 6
ER -