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Thiopental and deco...
Thiopental and decompressive craniectomy as last-tier ICP-treatments in aneurysmal subarachnoid hemorrhage : is functional recovery within reach?
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- Björk, Sofie (author)
- Uppsala universitet,Neurokirurgi
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- Hånell, Anders (author)
- Uppsala universitet,Neurokirurgi
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- Ronne-Engström, Elisabeth (author)
- Uppsala universitet,Neurokirurgi
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- Stenwall, Per-Anton (author)
- Uppsala universitet,Neurokirurgi
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- Velle, Fartein (author)
- Uppsala universitet,Neurokirurgi
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- Lewén, Anders, 1965- (author)
- Uppsala universitet,Neurokirurgi
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- Enblad, Per (author)
- Uppsala universitet,Neurokirurgi
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- Svedung-Wettervik, Teodor (author)
- Uppsala universitet,Neurokirurgi
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(creator_code:org_t)
- Springer Nature, 2023
- 2023
- English.
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In: Neurosurgical review. - : Springer Nature. - 0344-5607 .- 1437-2320. ; 46:1
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https://uu.diva-port... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Subject headings
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- The study aimed to investigate the indication and functional outcome after barbiturates and decompressive craniectomy (DC) as last-tier treatments for elevated intracranial pressure (ICP) in aneurysmal subarachnoid hemorrhage ( aSAH). This observational study included 891 aSAH patients treated at a single center between 2008 and 2018. Data on demography, admission status, radiology, ICP, clinical course, and outcome 1-year post-ictus were collected. Patients treated with thiopental ( barbiturate) and DC were the main target group. Thirty-nine patients (4%) were treated with thiopental alone and 52 (6%) with DC. These patients were younger and had a worse neurological status than those who did not require these treatments. Before thiopental, the median midline shift was 0 mm, whereas basal cisterns were compressed/obliterated in 66%. The median percentage of monitoring time with ICP > 20 mmHg immediately before treatment was 38%, which did not improve after 6 h of infusion. Before DC, the median midline shift was 10 mm, and the median percentage of monitoring time with ICP > 20 mmHg before DC was 56%, which both significantly improved postoperatively. At follow-up, 52% of the patients not given thiopental or operated with DC reached favorable outcome, whereas this occurred in 10% of the thiopental and DC patients. In summary, 10% of the aSAH cohort required thiopental, DC, or both. Thiopental and DC are important integrated last-tier treatment options, but careful patient selection is needed due to the risk of saving many patients into a state of suffering.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- Aneurysmal subarachnoid hemorrhage
- Decompressive craniectomy
- Intracranial pressure
- Outcome
- Thiopental
Publication and Content Type
- ref (subject category)
- art (subject category)
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