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Intracranial Pressure After Subarachnoid Hemorrhage*

Zoerle, Tommaso MD1; Lombardo, Alessandra MD1,2; Colombo, Angelo MD1; Longhi, Luca MD1,2; Zanier, Elisa R. MD3; Rampini, Paolo MD4; Stocchetti, Nino MD1,2

doi: 10.1097/CCM.0000000000000670
Neurologic Critical Care

Objectives: To describe mean intracranial pressure after aneurysmal subarachnoid hemorrhage, to identify clinical factors associated with increased mean intracranial pressure, and to explore the relationship between mean intracranial pressure and outcome.

Design: Analysis of a prospectively collected observational database.

Setting: Neuroscience ICU of an academic hospital.

Patients: One hundred sixteen patients with subarachnoid hemorrhage and intracranial pressure monitoring.

Interventions: None.

Measurements and Main Results: Episodes of intracranial pressure greater than 20 mm Hg lasting at least 5 minutes and the mean intracranial pressure for every 12-hour interval were analyzed. The highest mean intracranial pressure was analyzed in relation to demographic characteristics, acute neurologic status, initial radiological findings, aneurysm treatment, clinical vasospasm, and ischemic lesion. Mortality and 6-month outcome (evaluated using a dichotomized Glasgow Outcome Scale) were also introduced in multivariable logistic models. Eighty-one percent of patients had at least one episode of high intracranial pressure and 36% had a highest mean intracranial pressure more than 20 mm Hg. The number of patients with high intracranial pressure peaked 3 days after subarachnoid hemorrhage and declined after day 7. Highest mean intracranial pressure greater than 20 mm Hg was significantly associated with initial neurologic status, aneurysmal rebleeding, amount of blood on CT scan, and ischemic lesion within 72 hours from subarachnoid hemorrhage. Patients with highest mean intracranial pressure greater than 20 mm Hg had significantly higher mortality. When death, vegetative state, and severe disability at 6 months were pooled, however, intracranial pressure was not an independent predictor of unfavorable outcome.

Conclusions: High intracranial pressure is a common complication in the first week after subarachnoid hemorrhage in severe cases admitted to ICU. Mean intracranial pressure is associated with the severity of early brain injury and with mortality.

1Neuroscience ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, Milan, Italy.

2Department of Pathophysiology and Transplants, University of Milan, Milan, Italy.

3Department of Neuroscience, IRCCS–Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.

4Neurosurgery Division, Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, Milan, Italy.

* See also p. 253.

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Supported, in part, by institutional and departmental sources.

The authors have disclosed that they do not have any potential conflicts of interest.

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© 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins