Respiratory and swallowing outcomes based on aneurysm location in 360 patients with subarachnoid hemorrhage.

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Respiratory and swallowing outcomes based on aneurysm location in 360 patients with subarachnoid hemorrhage.

World Neurosurg. 2017 May 27;:

Authors: Abecassis IJ, Morton RP, McGrath L, Hanson J, Xue AH, Kelly CM, Levitt MR, Sekhar LN, Kim LJ

Abstract
INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) may result in abnormal respiratory and swallowing function. We analyzed factors that may influence long-term respiratory and swallowing function in aSAH patients, and compared patients with anterior and posterior aneurysm locations.
METHODS: We retrospectively reviewed 360 consecutive aSAH patients. We recorded location of the aneurysm and respiratory indices on admission, in-hospital adverse respiratory events and the need for tracheostomy (for respiratory failure) or percutaneous endoscopic gastrostomy (PEG) tube (for prolonged dysphagia). Respiratory and swallowing function was also reviewed at 1 year and at most recent clinical follow-up.
RESULTS: There were 293 (81.4%) anterior circulation and 67 (18.6%) posterior circulation aneurysms, including 31 patients with basilar artery aneurysms and 16 with posterior inferior cerebellar artery (PICA) aneurysms. There were no differences in oxygen saturation or PaO2:FiO2 ratio on admission, though patients with PICA aneurysms presented significantly more commonly with endotracheal intubation. PICA aneurysm patients had higher rates of tracheostomy and PEG tube dependence at 1 year in univariate analysis. Higher Hunt-Hess grade was a predictor of pneumonia and prolonged intubation, whereas older age and prolonged hospitalization were predictors of PEG placement in multivariate analysis.
CONCLUSIONS: Ruptured anterior and posterior circulation aneurysms have similar rates of in-hospital respiratory and swallowing dysfunction. There was a higher rate of swallowing dysfunction in the posterior circulation aneurysm group compared to the anterior group at most recent follow-up (12% vs 2%, p=0.035). Patients with PICA aneurysms demonstrated higher rates of tracheostomy and PEG, though the latter did not achieve statistical significance.

PMID: 28559079 [PubMed - as supplied by publisher]

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