Transpulmonary thermodilution monitoring-guided hemodynamic management improves cognitive function in patients with aneurysmal subarachnoid hemorrhage: a prospective cohort comparison.

Abstract

BackgroundThe effects of goal-directed hemodynamic management using transpulmonary thermodilution (TPT) monitor on the cognitive function of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain unclear. The present study aimed to determine whether hemodynamic management with TPT monitor provides better cognitive function compared with standard hemodynamic management.MethodsPatients with aSAH who were admitted to the intensive care unit in 2016 were assigned to cohort 1, and those admitted in 2017 were assigned to cohort 2. In cohort 1, hemodynamic and fluid management was performed in accordance with the traditional pressure-based hemodynamic parameters and clinical examination, whereas in cohort 2, it was performed in accordance with the TPT monitor-measured flow-based parameters. The incidence of delayed cerebral ischemia (DCI) and pulmonary edema (PE) was determined. The functional outcome of patients was assessed using the modified Rankin scale (mRS) score and Montreal cognitive assessment (MoCA) test at 1year following aSAH.ResultsCohort 1 included 45 patients and cohort 2 included 39 patients who completed the trial. The incidence of DCI (38% versus 26%) and PE (11% versus 3%) was comparable between the cohorts (p>0.05). The mRS score was similar between the cohorts (p=0.11). However, the MoCA score was 20.2 (19.2-21.4) and 23.5 (22.2-24.8) in cohort 1 and cohort 2, respectively (p<0.001). Accordingly, the occurrence of poor MoCA score (38% versus 18%) was significantly lower in cohort 2 (p=0.045).ConclusionsTPT monitor-based hemodynamic management provides better cognitive outcome than standard hemodynamic management in patients with aSAH.