Electroencephalographic Response to Sodium Nitrite May Predict Delayed Cerebral Ischemia after Severe Subarachnoid Hemorrhage

GARRY, P.S., ROWLAND, M.J., EZRA, M., HERIGSTAD, Mari, HAYEN, A., SLEIGH, J.W., WESTBROOK, J., WARNABY, C.E. and PATTINSON, K.T. (2016). Electroencephalographic Response to Sodium Nitrite May Predict Delayed Cerebral Ischemia after Severe Subarachnoid Hemorrhage. Critical Care Medicine, 44 (11), e1067-e1073.

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Link to published version:: https://doi.org/10.1097/CCM.0000000000001950


Objectives: Aneurysmal subarachnoid hemorrhage often leads to death and poor clinical outcome. Injury occurring during the first 72 hours is termed “early brain injury,” with disruption of the nitric oxide pathway playing an important pathophysiologic role in its development. Quantitative electroencephalographic variables, such as α/δ frequency ratio, are surrogate markers of cerebral ischemia. This study assessed the quantitative electroencephalographic response to a cerebral nitric oxide donor (intravenous sodium nitrite) to explore whether this correlates with the eventual development of delayed cerebral ischemia. Design: Unblinded pilot study testing response to drug intervention. Setting: Neuroscience ICU, John Radcliffe Hospital, Oxford, United Kingdom. Patients: Fourteen World Federation of Neurosurgeons grades 3, 4, and 5 patients (mean age, 52.8 yr [range, 41–69 yr]; 11 women). Interventions: IV sodium nitrite (10 μg/kg/min) for 1 hour. Measurements and Main Results: Continuous electroencephalographic recording for 2 hours. The alpha/delta frequency ratio was measured before and during IV sodium nitrite infusion. Seven of 14 patients developed delayed cerebral ischemia. There was a +30% to +118% (range) increase in the alpha/delta frequency ratio in patients who did not develop delayed cerebral ischemia (p < 0.0001) but an overall decrease in the alpha/delta frequency ratio in those patients who did develop delayed cerebral ischemia (range, +11% to –31%) (p = 0.006, multivariate analysis accounting for major confounds). Conclusions: Administration of sodium nitrite after severe subarachnoid hemorrhage differentially influences quantitative electroencephalographic variables depending on the patient’s susceptibility to development of delayed cerebral ischemia. With further validation in a larger sample size, this response may be developed as a tool for risk stratification after aneurysmal subarachnoid hemorrhage.

Item Type: Article
Uncontrolled Keywords: aneurysm; intracranial berry; brain injuries; electroencephalography; nitric oxide donors; spectrum analysis; subarachnoid hemorrhage; Adult; Aged; Aneurysm, Ruptured; Brain Ischemia; Electroencephalography; Female; Humans; Infusions, Intravenous; Intensive Care Units; Intracranial Aneurysm; Male; Middle Aged; Nitric Oxide Donors; Pilot Projects; Sodium Nitrite; Subarachnoid Hemorrhage; Humans; Brain Ischemia; Intracranial Aneurysm; Subarachnoid Hemorrhage; Aneurysm, Ruptured; Sodium Nitrite; Nitric Oxide Donors; Electroencephalography; Infusions, Intravenous; Pilot Projects; Adult; Aged; Middle Aged; Intensive Care Units; Female; Male; Emergency & Critical Care Medicine; 1103 Clinical Sciences; 1110 Nursing; 1117 Public Health and Health Services
Identification Number: https://doi.org/10.1097/CCM.0000000000001950
Page Range: e1067-e1073
SWORD Depositor: Symplectic Elements
Depositing User: Symplectic Elements
Date Deposited: 06 May 2020 14:24
Last Modified: 14 Mar 2024 12:08
URI: https://shura.shu.ac.uk/id/eprint/24945

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