Blood Pressure Management Goals in Critically Ill Aneurysmal Subarachnoid Hemorrhage Patients in Australia and New Zealand.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8910749 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1537-1921 (Electronic) Linking ISSN: 08984921 NLM ISO Abbreviation: J Neurosurg Anesthesiol Subsets: MEDLINE

Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: [New York, N.Y.] : Raven Press, [c1989-

Subarachnoid Hemorrhage*/therapy ; Subarachnoid Hemorrhage*/complications ; Blood Pressure* ; Critical Illness*; Humans ; New Zealand ; Australia ; Male ; Middle Aged ; Female ; Aged ; Adult ; Hypertension ; Vasospasm, Intracranial/etiology ; Vasospasm, Intracranial/therapy ; Antihypertensive Agents/therapeutic use ; Goals ; Treatment Outcome ; Critical Care/methods

Introduction: Blood pressure (BP) management is common in patients with aneurysmal subarachnoid hemorrhage (SAH) admitted to an intensive care unit. However, the practice patterns of BP management (timing, dose, and duration) have not been studied locally.
Methods: This post hoc analysis explored BP management goals (defined as the setting of a minimum systolic BP target or application of induced hypertension) in patients enrolled into the PROMOTE-SAH study in eleven neurosurgical centers in Australia and New Zealand. The primary outcome was 'dead or disabled' (modified Rankin Score ≥4) at 6 months, with the hypothesis being that setting BP management goals would be associated with improved outcomes.
Results: BP management goals were recorded in 266 of 357 (75%) patients, of which 149 were recorded as receiving induced hypertension for delayed cerebral ischemia (DCI) or vasospasm on 738 (19%) study days. In patients with a minimum systolic BP goal recorded (on 2067 d), the indication for the BP management goal was vasospasm or DCI on 651 (32%) days; no indication for BP management goals was documented on 1416 (69%) days. Crude analysis demonstrated an association between setting BP management goals and reduced death or disability ( P =0.03), but this association was not significant after adjustment for the presence of DCI or vasospasm and clustered by the site.
Conclusions: BP management goals are commonly 'prescribed' to aSAH patients admitted to an intensive care unit in Australia and New Zealand, but BP management goal setting was not associated with improved outcomes in the adjusted analysis.
Competing Interests: The authors have no no conflicts of interest to declare.
(Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

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Investigator: J Anstey; M Anstey; D Barge; R Bellomo; V Bhardwa; J Board; G Brinkerhoff; J Cohen; DJ Cooper; A Delaney; M Finnis; E Fitzgerald; O Flower; PM Healey; A Hunt; C Lawrence; J Mehrtens; L Newby; D Pearson; EP Raith; Y Robertson; S Schweikert; T Starr; M Tallott; AA Udy; A van der Poll; P Young

0 (Antihypertensive Agents)

Date Created: 20230713 Date Completed: 20240610 Latest Revision: 20240610

20240610

PMC11161225

10.1097/ANA.0000000000000926

37442781