Invasives Atemwegsmanagement bei patienten mit aneurysmatische subarachnoidalblutung

Nearly every patient with a ruptured intracranial aneurysm must be ventilated in the intensive care unit (ICU). A range of primary and secondary complications after this event burdens the quality of life of these patients. This study aims to identify the role of invasive ventilation management and elucidate its future part in improving outcomes in aneurysmal subarachnoid hemorrhage (aSAH).

All consecutive cases with aSAH treated at our institution between 01/2003 and 06/2016 were eligible for this study. Invasive ventilation parameters like duration of continuous positive airway pressure (CPAP) ventilation, duration of other forms of invasive ventilation, days with sedated ventilation, highest ventilation frequency, highest and mean positive end-expiratory pressure (PEEP) in [mbar], and maximal and mean-maximal inspiratory pressure (Pinsp) in [mbar] were analyzed in univariate and multivariate analyses. The association of ventilation parameters with the primary study endpoints (risk of cerebral infarction, in-hospital mortality, and unfavorable outcome at six months defined as modified Rankin scale>3) was analyzed.

The final cohort (n = 759) comprised patients between 19 and 90 years old with at least one day of invasive ventilation. Unfavorable functional outcomes were reported in 49% of the cases, ischemic insults occurred in 54.1% of the patients, and the in-hospital mortality rate was 20.6%. Furthermore, extended periods of CPAP ventilation (OR: 1.03, CI: 1.02-1.05), longer sedated ventilation (OR:1.02, CI: 1.01-1.04), and an elevated maximal Pinsp (OR: 1.03, CI: 1.01-1.04) showed higher chances for an unfavorable functional outcome after six months. In addition, ischemic insults were linked to sedated ventilation days (OR: 1.02, CI: 1.01-1.03) and an elevated maximal Pinsp (OR: 1.01, CI: 1.003-1.02). Lastly, in-hospital mortality was shown to be associated with higher PEEPs (OR: 1.02, CI: 1.01-1.03) and an elevated maximal Pinsp (OR: 1.02, CI: 1.01-1.03).

In conclusion, a variety of ventilation parameters are linked to unfavorable outcomes. Prominent was the association between longer sedation times, risk for ischemic insults, and higher risks of poor functional outcomes post-discharge. These findings underline the critical role of ventilation parameters assessment in managing patient outcomes.