Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage.


OBJECTIVE:To determine the effect that acute physiologic derangements have on outcome after subarachnoid hemorrhage (SAH) and to design a composite score summarizing these abnormalities. DESIGN:Prospective observational study. SETTING:Neuroscience intensive care unit in a tertiary care academic center. PATIENTS:Consecutive cohort of 413 patients with SAH admitted within 3 days of SAH onset with 3-month modified Rankin Scale scores. INTERVENTIONS:None. RESULTS:Among 20 physiologic variables assessed within 24 hrs of admission, four were independently associated with death or severe disability (modified Rankin Scale score, 4-6) at 3 months in a multivariate analysis: arterio-alveolar gradient of >125 mm Hg (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.7-7.6), serum bicarbonate of <20 mmol/L (OR, 2.9; 95% CI, 1.6-5.6), serum glucose of >180 mg/dL (OR, 2.8; 95% CI, 1.6-4.8), and mean arterial pressure of <70 or >130 mm Hg (OR, 1.7; 95% CI, 1.0-2.9). Based on their proportional contribution to outcome, we constructed the SAH Physiologic Derangement Score (SAH-PDS; range, 0-8) by assigning the following weights for abnormal findings: arterio-alveolar gradient, 3 points; bicarbonate, 2 points; glucose, 2 points; and mean arterial pressure, 1 point. After controlling for known predictors of death or severe disability (age, admission neurologic status, loss of consciousness, aneurysm size, intraventricular hemorrhage, and rebleeding), the SAH Physiologic Derangement Score was independently associated with poor outcome (OR, 1.3 for each point increase; 95% CI, 1.1-1.6). By contrast, the systemic inflammatory response syndrome score and the Acute Physiology and Chronic Health Evaluation II physiologic subscore did not add predictive value to the model. CONCLUSION:Acute interventions specifically targeting hypoxemia, metabolic acidosis, hyperglycemia, and cardiovascular instability may improve the outcome of SAH patients. The SAH Physiologic Derangement Score may prove useful for rapidly quantifying the severity of important physiologic derangements in acute SAH.


Crit Care Med


Critical care medicine


Claassen J,Vu A,Kreiter KT,Kowalski RG,Du EY,Ostapkovich N,Fitzsimmons BF,Connolly ES,Mayer SA




Has Abstract


2004-03-01 00:00:00














  • Brain Injury and Neurologic Outcome in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis.

    abstract:OBJECTIVES:Extracorporeal cardiopulmonary resuscitation has shown survival benefit in select patients with refractory cardiac arrest but there is insufficient data on the frequency of different types of brain injury. We aimed to systematically review the prevalence, predictors of and survival from neurologic complicati...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Migdady I,Rice C,Deshpande A,Hernandez AV,Price C,Whitman GJ,Geocadin RG,Cho SM

    更新日期:2020-07-01 00:00:00

  • Changes in Temperature Management of Cardiac Arrest Patients Following Publication of the Target Temperature Management Trial.

    abstract:OBJECTIVES:To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. S...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Salter R,Bailey M,Bellomo R,Eastwood G,Goodwin A,Nielsen N,Pilcher D,Nichol A,Saxena M,Shehabi Y,Young P,Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE).

    更新日期:2018-11-01 00:00:00

  • The Randomized Educational Acute Respiratory Distress Syndrome Diagnosis Study: A Trial to Improve the Radiographic Diagnosis of Acute Respiratory Distress Syndrome.

    abstract:OBJECTIVES:Radiographic criteria for acute respiratory distress syndrome have been criticized for poor reliability. Our objective was to test an educational intervention to improve the radiographic identification of acute respiratory distress syndrome by participants in the Large Observational Study to Understand the G...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Goddard SL,Rubenfeld GD,Manoharan V,Dev SP,Laffey J,Bellani G,Pham T,Fan E

    更新日期:2018-05-01 00:00:00

  • Lipid peroxidation in experimental septic rats.

    abstract::We previously reported increased lipid peroxide and decreased alpha-tocopherol levels in the blood of critically ill septic patients. To clarify these results, we investigated lipid peroxidation in experimental septic rats and severely traumatized rats. In septic rats, both platelet count and plasma alpha-tocopherol d...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Takeda K,Shimada Y,Okada T,Amano M,Sakai T,Yoshiya I

    更新日期:1986-08-01 00:00:00

  • Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis.

    abstract:OBJECTIVE:To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables. DESIGN:Prospective, observational, cohort study. SETTING:Twelve French medical or surgical intensive care un...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Clec'h C,Alberti C,Vincent F,Garrouste-Orgeas M,de Lassence A,Toledano D,Azoulay E,Adrie C,Jamali S,Zaccaria I,Cohen Y,Timsit JF

    更新日期:2007-01-01 00:00:00

  • Hypoxia-reoxygenation is as damaging as ischemia-reperfusion in the rat liver.

    abstract:OBJECTIVE:We hypothesized that the extent of injury and release of xanthine oxidase, an oxidant generator, into the circulation would be less in normal-flow hypoxia-reoxygenation than in equal duration no-flow ischemia-reperfusion. DESIGN:Randomized study. SETTING:University-based animal research facility. SUBJECTS:...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Tan S,Yokoyama Y,Wang Z,Zhou F,Nielsen V,Murdoch AD,Adams C,Parks DA

    更新日期:1998-06-01 00:00:00

  • Determinants of tidal volume during high-frequency oscillation.

    abstract:OBJECTIVE:High-frequency oscillation has been proposed for use in adult acute respiratory distress syndrome. However, limited data are available on the effect of pressure amplitude and rate (Hz) on tidal volumes delivered during high-frequency oscillation in adults. DESIGN:Prospective, animal model, lung injury study....

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Sedeek KA,Takeuchi M,Suchodolski K,Kacmarek RM

    更新日期:2003-01-01 00:00:00

  • Reporting of Sepsis Cases for Performance Measurement Versus for Reimbursement in New York State.

    abstract:OBJECTIVES:Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database. DESIGN:Observa...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Prescott HC,Cope TM,Gesten FC,Ledneva TA,Friedrich ME,Iwashyna TJ,Osborn TM,Seymour CW,Levy MM

    更新日期:2018-05-01 00:00:00

  • Application of a Framework to Assess the Usefulness of Alternative Sepsis Criteria.

    abstract::The current definition of sepsis is life-threatening, acute organ dysfunction secondary to a dysregulated host response to infection. Criteria to operationalize this definition can be judged by six domains of usefulness (reliability, content, construct and criterion validity, measurement burden, and timeliness). The r...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Seymour CW,Coopersmith CM,Deutschman CS,Gesten F,Klompas M,Levy M,Martin GS,Osborn TM,Rhee C,Warren DK,Watson RS,Angus DC

    更新日期:2016-03-01 00:00:00

  • Attitudes and preferences of intensivists regarding the role of family interests in medical decision making for incompetent patients.

    abstract:OBJECTIVE:The role of family interests in medical decision making is controversial. Physicians who routinely treat incompetent patients may have preferred strategies for addressing family interests as they are encountered in surrogate medical decision making. We sought to determine how physicians view the role of famil...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Hardart GE,Truog RD

    更新日期:2003-07-01 00:00:00

  • The Period 2 Enhancer Nobiletin as Novel Therapy in Murine Models of Circadian Disruption Resembling Delirium.

    abstract:OBJECTIVES:Delirium occurs in approximately 30% of critically ill patients, and the risk of dying during admission doubles in those patients. Molecular mechanisms causing delirium are largely unknown. However, critical illness and the ICU environment consistently disrupt circadian rhythms, and circadian disruptions are...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Gile J,Scott B,Eckle T

    更新日期:2018-06-01 00:00:00

  • Nitrogen balance, protein loss, and the open abdomen.

    abstract:OBJECTIVE:Goal-directed nutritional support is essential to improving morbidity and mortality. Open abdominal decompression is similarly crucial to the successful treatment of intra-abdominal hypertension and abdominal compartment syndrome. The open abdomen, however, places the patient at risk for potentially significa...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Cheatham ML,Safcsak K,Brzezinski SJ,Lube MW

    更新日期:2007-01-01 00:00:00

  • Ventriculo-Arterial Coupling Analysis Predicts the Hemodynamic Response to Norepinephrine in Hypotensive Postoperative Patients: A Prospective Observational Study.

    abstract:OBJECTIVES:The objectives of the present study were to evaluate, in patients with persistent arterial hypotension in the immediate postcardiac surgery period, the effects of norepinephrine infusion on ventriculo-arterial coupling, its determinants: arterial elastance and end-systolic ventricular elastance, and to test ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Guinot PG,Longrois D,Kamel S,Lorne E,Dupont H

    更新日期:2018-01-01 00:00:00

  • Sucrose malabsorption and impaired mucosal integrity in enterally fed critically ill patients: a prospective cohort observational study.

    abstract:OBJECTIVE:Inadequate nutrition is common in critical illness due in part to gastric stasis. However, recent data suggest that altered small intestinal mucosal function may be a contributing factor. The aim of this study was to examine the effects of critical illness on sucrose absorption, permeability, and mucosal morp...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Burgstad CM,Besanko LK,Deane AM,Nguyen NQ,Saadat-Gilani K,Davidson G,Burt E,Thomas A,Holloway RH,Chapman MJ,Fraser RJ

    更新日期:2013-05-01 00:00:00

  • Effects of disposable or interchangeable positive end-expiratory pressure valves on work of breathing during the application of continuous positive airway pressure.

    abstract:OBJECTIVE:To determine which of a series of disposable or interchangeable positive end-expiratory pressure (PEEP) devices functions with the least imposition of inspiratory and expiratory work during continuous positive airway pressure. DESIGN:Prospective laboratory evaluation performed on a lung model. SETTING:Resea...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Kacmarek RM,Mang H,Barker N,Cycyk-Chapman MC

    更新日期:1994-08-01 00:00:00

  • Effects of an angiotensin-converting enzyme inhibitor on the inflammatory response in in vivo and in vitro models.

    abstract:OBJECTIVE:Sepsis remains a major health threat in intensive care medicine. The renin-angiotensin system (ACE) affects inflammatory responses. In addition, angiotensin-converting enzyme inhibitors act to ameliorate lung injury. To investigate whether the widely used ACE inhibitor enalapril, used to treat hypertension, c...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Hagiwara S,Iwasaka H,Matumoto S,Hidaka S,Noguchi T

    更新日期:2009-02-01 00:00:00

  • The Use of Central Venous to Arterial Carbon Dioxide Tension Gap for Outcome Prediction in Critically Ill Patients: A Systematic Review and Meta-Analysis.

    abstract:OBJECTIVES:In this systematic review and meta-analysis, we assessed whether a high CO2 gap predicts mortality in adult critically ill patients with circulatory shock. DATA SOURCES:A systematic search of MEDLINE and EMBASE electronic databases from inception to October 2019. STUDY SELECTION:Studies from adult (age ≥ 1...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Al Duhailib Z,Hegazy AF,Lalli R,Fiorini K,Priestap F,Iansavichene A,Slessarev M

    更新日期:2020-12-01 00:00:00

  • Venous hypercarbia in canine hemorrhagic shock.

    abstract::The venous-arterial PCO2 gradient may increase in certain low-flow states, such as CPR and canine endotoxemia. To determine whether venous hypercarbia also occurs in hemorrhagic shock, we studied 12 anesthetized, mechanically ventilated dogs. We performed laparotomies on the animals, inserting catheters into their ren...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Benjamin E,Paluch TA,Berger SR,Premus G,Wu C,Iberti TJ

    更新日期:1987-05-01 00:00:00

  • Cytokine Release Syndrome After Chimeric Antigen Receptor T Cell Therapy for Acute Lymphoblastic Leukemia.

    abstract:OBJECTIVE:Initial success with chimeric antigen receptor-modified T cell therapy for relapsed/refractory acute lymphoblastic leukemia is leading to expanded use through multicenter trials. Cytokine release syndrome, the most severe toxicity, presents a novel critical illness syndrome with limited data regarding diagnos...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Fitzgerald JC,Weiss SL,Maude SL,Barrett DM,Lacey SF,Melenhorst JJ,Shaw P,Berg RA,June CH,Porter DL,Frey NV,Grupp SA,Teachey DT

    更新日期:2017-02-01 00:00:00

  • Simple and accurate monitoring of end-tidal carbon dioxide tensions during high-frequency jet ventilation.

    abstract::To determine whether end-tidal carbon dioxide tension (PETCO2) accurately reflects PaCO2 during high-frequency jet ventilation (HFJV), 43 studies were performed on eight mongrel dogs with normal lungs. During HFJV, minute volume was modified to obtain a range of PaCO2 values from 15.5 to 74.5 torr. When PETCO2 was mea...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Algora-Weber A,Rubio JJ,Dominguez de Villota E,Cortes JL,Gomez D,Mosquera JM

    更新日期:1986-10-01 00:00:00

  • Guide to ethical decision-making for the critically ill: the three R's and Q.C.

    abstract::Ethical decision-making for the care of the critically ill and injured has never been more difficult than it is today. Major technologic advances prolong life but often provide questionable benefit in human terms. Both the ethical commitment to the individual patient and the competition for access to expensive and sca...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Weil MH,Weil CJ,Rackow EC

    更新日期:1988-06-01 00:00:00

  • Continuous lateral rotation therapy to prevent ventilator-associated pneumonia.

    abstract:OBJECTIVE:To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN:Prospective, randomized, clinical study. SETTING:Three medical inte...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Staudinger T,Bojic A,Holzinger U,Meyer B,Rohwer M,Mallner F,Schellongowski P,Robak O,Laczika K,Frass M,Locker GJ

    更新日期:2010-02-01 00:00:00

  • Clinical correlates of successful weaning from mechanical ventilation in severe bronchopulmonary dysplasia.

    abstract::The hospital records of 7 patients with severe bronchopulmonary dysplasia (BPD) were reviewed. All patients were ventilator dependent for prolonged periods (mean duration intermittent mandatory ventilation (IMV) 14.3 +/- 3.5 months) but eventually were successfully weaned from mechanical ventilation and sent home. The...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Morray JP,Fox WW,Kettrick RG,Downes JJ

    更新日期:1981-12-01 00:00:00

  • Energy expenditure and withdrawal of sedation in severe head-injured patients.

    abstract:OBJECTIVES:To determine the outcome of oxygen consumption (VO2) and energy expenditure after cessation of sedation in severe head-injured patients and to assess its usefulness as a predictor of neurologic severity. DESIGN:Prospective, descriptive study. SETTING:Neurosurgical intensive care unit (ICU) in a university ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Bruder N,Lassegue D,Pelissier D,Graziani N,François G

    更新日期:1994-07-01 00:00:00

  • Hepcidin and Anemia in Surgical Critical Care: A Prospective Cohort Study.

    abstract:OBJECTIVE:Because anemia of inflammation is common in ICU patients and hepcidin is the key regulator of iron homeostasis, we examined time-dependent changes in hepcidin, erythropoietin, iron, and inflammatory markers in surgical ICU patients with anemia. DESIGN:Prospective single-center clinical noninterventional stud...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Cherry-Bukowiec JR,Engoren M,Wiktor A,Raghavendran K,Napolitano LM

    更新日期:2018-06-01 00:00:00

  • Hypoxemic resuscitation prevents pulmonary capillary endothelial dysfunction induced by normoxemic resuscitation from hemorrhagic shock.

    abstract:OBJECTIVE:Hypoxemic reperfusion attenuates brain injury secondary to severe cerebral ischemia, myocardial, and intestinal injury occurring in intestinal postischemic shock, and offers hemodynamic stabilization and attenuation of inflammatory response when applied in the resuscitation from hemorrhagic shock. In this stu...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Douzinas EE,Orfanos SE,Livaditi O,Augustatou K,Villiotou V,Kavantzas N,Flevari A,Korkolopoulou P,Roussos C,Patsouris E

    更新日期:2009-03-01 00:00:00

  • National estimates of intensive care utilization and costs: Canada and the United States.

    abstract::Although ICUs generate attention as consumers of resources, no national data on utilization and costs were available in Canada. U.S. estimates are too old for current comparison. Based on national hospital survey data from Statistics Canada, we calculated the utilization of ICUs in all Canadian general hospitals from ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Jacobs P,Noseworthy TW

    更新日期:1990-11-01 00:00:00

  • Use of a Novel, Electronic Health Record-Centered, Interprofessional ICU Rounding Simulation to Understand Latent Safety Issues.

    abstract:OBJECTIVES:The electronic health record is a primary source of information for all professional groups participating in ICU rounds. We previously demonstrated that, individually, all professional groups involved in rounds have significant blind spots in recognition of patient safety issues in the electronic health reco...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Bordley J,Sakata KK,Bierman J,McGrath K,Mulanax A,Nguyen L,Mohan V,Gold JA

    更新日期:2018-10-01 00:00:00

  • Polynitroxylated pegylated hemoglobin: a novel neuroprotective hemoglobin for acute volume-limited fluid resuscitation after combined traumatic brain injury and hemorrhagic hypotension in mice.

    abstract:OBJECTIVE:Resuscitation of hemorrhagic hypotension after traumatic brain injury is challenging. A hemoglobin-based oxygen carrier may offer advantages. The novel therapeutic hemoglobin-based oxygen carrier, polynitroxylated pegylated hemoglobin (PNPH), may represent a neuroprotective hemoglobin-based oxygen carrier for...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Shellington DK,Du L,Wu X,Exo J,Vagni V,Ma L,Janesko-Feldman K,Clark RS,Bayir H,Dixon CE,Jenkins LW,Hsia CJ,Kochanek PM

    更新日期:2011-03-01 00:00:00

  • Morbid obesity is an independent determinant of death among surgical critically ill patients.

    abstract:OBJECTIVE:To determine whether extreme obesity (morbid obesity; body mass index > or =40 kg/m(2)) is an independent risk factor for death among critically ill patients; this objective is most salient in the subset of patients who sustain a prolonged intensive care unit stay during which the burdens of care imposed by o...

    journal_title:Critical care medicine

    pub_type: 评论,杂志文章


    authors: Nasraway SA Jr,Albert M,Donnelly AM,Ruthazer R,Shikora SA,Saltzman E

    更新日期:2006-04-01 00:00:00