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Vasospasm Risk in Surgical ICU Patients With Grade I Subarachnoid Hemorrhage FREE TO VIEW

George Lominadze, MD; Samantha Lessen; Adam Keene, MD
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Montefiore Medical Center, Bronx, NY

Chest. 2015;148(4_MeetingAbstracts):238A. doi:10.1378/chest.2275067
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SESSION TITLE: Critical Care Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality. The initial hemorrhage causes death in approximately 25% of patients, with most subsequent mortality being attributable to delayed cerebral ischemia (DCI). DCI generally occurs on post bleed days 4 through 20, with the incidence peaking at day 8. Because of the risks of DCI, patients with SAH are usually monitored in an ICU for 14-21 days. Unfortunately, prolonged ICU admissions are expensive and are associated with well documented risks to patients. We hypothesized that a subset of patients who are at low risk for DCI should be safe to transfer out of the ICU early.

METHODS: All patients admitted to Montefiore Medical Center from 2008-2013 with grade I SAH who had their aneurysms successfully protected, had an uncomplicated postoperative course, and had no clinical or ultrasonographic evidence of DCI after day 8 were retrospectively studied. The primary outcome was clinical or ultrasonographic evidence of the development of DCI after day 8. Secondary outcomes included length of ICU and hospital stay, and hospital mortality.

RESULTS: 40 patients who met the above criteria were identified. Of these, only 1 (2.5%) developed ultrasonographic evidence of DCI after day 8, but required no intervention. The mean length of stay in the ICU was until post-bleed day 13 and the mean hospital length of stay was until post-bleed day 14. The in-hospital mortality was 0/40.

CONCLUSIONS: we identified a low-risk subset of patients with grade I SAH who may be candidates for early transfer out of the ICU.

CLINICAL IMPLICATIONS: The study allows for the reduction of the ICU length of stay in a subset of patients with grade 1 subarachnoid hemorrhage.

DISCLOSURE: The following authors have nothing to disclose: George Lominadze, Samantha Lessen, Adam Keene

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