Early multimodal neuromonitoring is associated with outcomes in critically ill patients with hemorrhagic stroke.

Abstract

INTRODUCTION: Early outcome prediction in critically ill patients with spontaneous intracerebral haemorrhage (ICH) remains challenging. Invasive multimodal neuromonitoring may offer prognostic insights. METHODS: We conducted a single-centre retrospective observational study including critically ill ICH patients admitted to the Neurocritical Care Unit between January 2015 and September 2021. Neuromonitoring variables were analysed during the first 48 h and included intracranial pressure (ICP), cerebral perfusion pressure (CPP), pressure reactivity index (PRx), and optimal CPP (CPPopt). Six-month functional outcomes were assessed using the modified Rankin Scale (mRS) score and dichotomized as severe if death or vegetative state (mRS score 5-6) or nonsevere (mRS score 1-4). RESULTS: Among 65 patients with a mean age of 62.6 ± 13.2 years, the mean PRx was significantly higher in patients with a severe outcome (0.27 ± 0.27 vs. 0.12 ± 0.18; p = 0.008). The difference between real CPP and CPPopt was negative in the severe outcome group and positive in the non-severe group (-4.79 ± 13.6 mmHg vs. +3.99 ± 15.3 mmHg; p = 0.020). The ICP values did not differ significantly between groups and were <21 mmHg in both groups. In multivariable analysis, higher PRx (OR 1.05, 95% CI 1.01-1.10; p = 0.025) and negative CPP-CPPopt deviation (OR 0.95, 95% CI 0.91-0.99; p = 0.028) were independently associated with severe outcome. DISCUSSION: Although ICP is the most extensively studied neuromonitoring parameter, it may not be the most informative parameter associated with outcome in this population during the early phase. Critically ill patients with ICH who exhibit impaired cerebrovascular reactivity (PRx > 0.2) or lower CPP than CPPopt within the first 48 h were associated with a higher likelihood of poor functional outcomes at 6 months. These findings support the hypothesis that advanced neuromonitoring parameters may provide additional prognostic information beyond mean ICP values in this population. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT05501613.