Hémorragie sousarachnoïdienne et complications cardiopulmonaire graves

Diplôme Thèse Hémorragie sousarachnoïdienne et complications cardiopulmonaire graves eng 2009 author Macrea Lucian Mihai 112521 director Walder Bernhard 124875 10.13097/archive-ouverte/unige:2247 urn:nbn:ch:unige-22474 Méd. 10580 The association between the degree of neurological deficit and cardiopulmonary dysfunction in patients with spontaneous subarachnoid hemorrhage (SAH) is poorly understood. Method: A systematic search (MEDLINE, bibliographies, to 9.2004) was performed for prospective studies (any architecture; =10 patients with SAH), reporting on neurological deficit and cardiopulmonary dysfunction. Neurological deficit was graded according to the Hunt-Hess or Botterell scores as minimal (1 or 2 points), moderate (3), or severe (4 or 5), and tested for an association with cardiopulmonary dysfunction (chisquare test). Results: Relevant data came from two randomized trials, four case-control studies, and 31 uncontrolled series. In eight studies (386 patients), ECG abnormalities were found in 32% of patients with minimal, 55% with moderate, and 58% with severe neurological deficit (P<0.0001). In six studies (135), echocardiographic abnormalities were found in 4% of patients with minimal, 30% with moderate, and 52% with severe neurological deficit (P=0.0001). In two trials (63), reatinine phosphoskinase was increased in 18% of patients with minimal, 71% with moderate, and 100% with severe neurological deficit (P<0.0001). In three trials (309), troponin-I was increased in 10% of patients with minimal, 20% of patients with moderate, and 46% with severe neurological deficit (P<0.0001). In five trials (163), pulmonary edema was found in 4% of patients with minimal, 12% with moderate, and 35% with severe neurological deficit (P<0.0001). Seventeen studies reported on mortality; 26% of the patients died, 80% of deaths were directly related to SAH. Conclusions: In patients with spontaneous SAH, cardiopulmonary dysfunction is more likely to occur with increasing neurological deficit. Subarachnoid hemorrhage Meta-analysis Cardiac function Echocardiography Myocardial ischemia Pulmonary edema Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false bd10c9a9-0fd9-4e1e-9910-fcbb3670a25a Thesis Public these-MacreaL.pdf 1156819 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Hémorragie sousarachnoïdienne et complications cardiopulmonaire graves				2009	904	1,815

Archive ouverte UNIGE

Macrea, Lucian Mihai