Sedation Patterns and Hyperosmolar Therapy in Emergency Departments Were Associated with Blood Pressure Variability and Outcomes in Patients with Spontaneous Intracranial Hemorrhage

Overview

Journal J Emerg Trauma Shock

Specialty Emergency Medicine

Date 2020 Oct 5

PMID 33013096

Authors

Tina Nguyen

Kanisha Pope

Paul Capobianco

Mimi Cao-Pham

Soha Hassan

Matthew J Kole

Claire OConnell

Aaron Wessell

Jonathan Strong

Quincy K Tran

Affiliations

Soon will be listed here.

Abstract

Background: Spontaneous intracranial hemorrhage (sICH) is associated with high mortality. Little information exists to guide initial resuscitation in the emergency department (ED) setting. However, blood pressure variability (BPV) and mechanical ventilation (MV) are known risk factors for poor outcome in sICH.

Objectives: The objective was to examine the associations between BPV and MV in ED (EDMV) and between two ED interventions - post-MV sedation and hyperosmolar therapy for elevated intracranial pressure - and BPV in the ED and in-hospital mortality.

Methods: We retrospectively studied adults with sICH and external ventricular drainage who were transferred to a quaternary academic medical center from other hospitals between January 2011 and September 2015. We used multivariable linear and logistic regressions to measure associations between clinical factors, BPV, and outcomes.

Results: We analyzed ED records from 259 patients. There were 143 (55%) EDMV patients who had more severe clinical factors and significantly higher values of all BPV indices than NoEDMV patients. Two clinical factors and none of the severity scores (i.e., Hunt and Hess, World Federation of Neurological Surgeons Grades, ICH score) correlated with BPV. Hyperosmolarity therapy without fluid resuscitation positively correlated with all BPV indices, whereas propofol infusion plus a narcotic negatively correlated with one of them. Two BPV indices, i.e., successive variation of blood pressure (BP) and absolute difference in blood pressure between ED triage and departure (BP), were significantly associated with increased mortality rate.

Conclusion: Patients receiving MV had significantly higher BPV, perhaps related to disease severity. Good ED sedation, hyperosmolar therapy, and fluid resuscitation were associated with less BPV and lower likelihood of death.

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