Desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm
Introducción: la hemorragia subaracnoidea (HSA) es una patología del sistema nervioso central, con una elevada morbimortalidad. Los ensayos clínicos con terapias farmacológicas posiblemente no se vean afectados por la ubicación geográfica del paciente, particularmente por la altura a diferencia de l...
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| Formato: | Tesis de maestría (Master Thesis) |
| Lenguaje: | Español (Spanish) |
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Universidad del Rosario
2020
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| Acceso en línea: | https://repository.urosario.edu.co/handle/10336/20883 |
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ir-10336-20883 |
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EdocUR - Universidad del Rosario |
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Español (Spanish) |
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Hemoglobina Altitud Hemorragia Subaracnoidea Transfusión Funcionalidad Ginecología & otras especialidades médicas Cuidados intensivos neurológicos Hemorragia cerebral-Tratamiento-Investigaciones Hemorragia subaracnoidea (HSA) Oxígeno en la sangres-Análisis Hemoglobin Altitude Subarachnoid Hemorrhage Transfusion Functionality |
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Hemoglobina Altitud Hemorragia Subaracnoidea Transfusión Funcionalidad Ginecología & otras especialidades médicas Cuidados intensivos neurológicos Hemorragia cerebral-Tratamiento-Investigaciones Hemorragia subaracnoidea (HSA) Oxígeno en la sangres-Análisis Hemoglobin Altitude Subarachnoid Hemorrhage Transfusion Functionality Palomino Mantilla, Carlos Mario Desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm |
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Introducción: la hemorragia subaracnoidea (HSA) es una patología del sistema nervioso central, con una elevada morbimortalidad. Los ensayos clínicos con terapias farmacológicas posiblemente no se vean afectados por la ubicación geográfica del paciente, particularmente por la altura a diferencia de la terapia con hemoderivados cuya relación con la presión atmosférica y el transporte de oxigeno genera incógnitas en ciudades de diferente altitud. Objetivo: Evaluar la relación del desenlace funcional neurológico favorable (Rankin modificado <3) vs. desfavorable (Rankin modificada 4) y su relación con el punto de corte de 10 gr/dl hemoglobina previo a transfusión, en pacientes con diagnóstico de hemorragia subaracnoidea, hospitalizados en la unidad de cuidados neurocríticos del Hospital Universitario Fundación Sante Fe de Bogotá a 2600 ms. n. m. Metodología: Estudio observacional retrospectivo de casos y controles basado en una cohorte histórica de pacientes con HSA, de enero 2010 a diciembre 2018 en Unidad de Cuidado Intensivo Neurológico. Resultados: No se encontró una relación entre desenlace funcional favorable y transfusión con nivel de hemoglobina con punto de corte de 10 gr/dL OR 1.111 (p= 0.865 95% IC 0.328 - 3.755). Conclusión: No se demostró una asociación favorable o desfavorable entre el punto de corte de hemoglobina y el desenlace neurológico funcional, no es posible realizar una recomendación frente al umbral transfusional. No se evidenció un efecto deletéreo de la transfusión sanguínea, no se evidencio aumento de episodios de vaso espasmo o isquemia cerebral tardía. |
| author2 |
Carrizosa Gonzalez, Jorge Armando |
| author_facet |
Carrizosa Gonzalez, Jorge Armando Palomino Mantilla, Carlos Mario |
| format |
Tesis de maestría (Master Thesis) |
| author |
Palomino Mantilla, Carlos Mario |
| author_sort |
Palomino Mantilla, Carlos Mario |
| title |
Desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm |
| title_short |
Desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm |
| title_full |
Desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm |
| title_fullStr |
Desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm |
| title_full_unstemmed |
Desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm |
| title_sort |
desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm |
| publisher |
Universidad del Rosario |
| publishDate |
2020 |
| url |
https://repository.urosario.edu.co/handle/10336/20883 |
| _version_ |
1694382428931489792 |
| spelling |
ir-10336-208832021-03-01T19:22:49Z Desenlace funcional y hemoglobina en pacientes neurocríticos con hemorragia subaracnoidea a 2600 msnm Functional outcome and hemoglobin in neurocritical patients with subarachnoid hemorrhage at 2600 masl Palomino Mantilla, Carlos Mario Carrizosa Gonzalez, Jorge Armando Carreño Rodríguez, José Nel Hemoglobina Altitud Hemorragia Subaracnoidea Transfusión Funcionalidad Ginecología & otras especialidades médicas Cuidados intensivos neurológicos Hemorragia cerebral-Tratamiento-Investigaciones Hemorragia subaracnoidea (HSA) Oxígeno en la sangres-Análisis Hemoglobin Altitude Subarachnoid Hemorrhage Transfusion Functionality Introducción: la hemorragia subaracnoidea (HSA) es una patología del sistema nervioso central, con una elevada morbimortalidad. Los ensayos clínicos con terapias farmacológicas posiblemente no se vean afectados por la ubicación geográfica del paciente, particularmente por la altura a diferencia de la terapia con hemoderivados cuya relación con la presión atmosférica y el transporte de oxigeno genera incógnitas en ciudades de diferente altitud. Objetivo: Evaluar la relación del desenlace funcional neurológico favorable (Rankin modificado <3) vs. desfavorable (Rankin modificada 4) y su relación con el punto de corte de 10 gr/dl hemoglobina previo a transfusión, en pacientes con diagnóstico de hemorragia subaracnoidea, hospitalizados en la unidad de cuidados neurocríticos del Hospital Universitario Fundación Sante Fe de Bogotá a 2600 ms. n. m. Metodología: Estudio observacional retrospectivo de casos y controles basado en una cohorte histórica de pacientes con HSA, de enero 2010 a diciembre 2018 en Unidad de Cuidado Intensivo Neurológico. Resultados: No se encontró una relación entre desenlace funcional favorable y transfusión con nivel de hemoglobina con punto de corte de 10 gr/dL OR 1.111 (p= 0.865 95% IC 0.328 - 3.755). Conclusión: No se demostró una asociación favorable o desfavorable entre el punto de corte de hemoglobina y el desenlace neurológico funcional, no es posible realizar una recomendación frente al umbral transfusional. No se evidenció un efecto deletéreo de la transfusión sanguínea, no se evidencio aumento de episodios de vaso espasmo o isquemia cerebral tardía. Introduction: subarachnoid hemorrhage (SAH) is a devastating pathology of the central nervous system, with high morbidity and mortality. Clinical trials of pharmacological therapies may not be affected by the patient's geographic location, particularly by height as therapy with blood products whose relationship with atmospheric pressure and oxygen transport generates areas of uncertainty in cities of higher altitude. Objective: To evaluate the relationship of favorable neurological functional outcome (modified Rankin <3) vs. unfavorable (modified Rankin 4) with a cut-off point of 10 gr / dl hemoglobin prior to transfusion in patients diagnosed with subarachnoid hemorrhage, hospitalized in the neurocritical care unit of the Santa Fe de Bogotá Foundation at 2600 ms. n. m. Methodology: Retrospective observational study of cases and controls based on a historical cohort of patients with SAH, from January 2010 to December 2018 in the Neurological Intensive Care Unit. Results: No relationship was found between favorable functional outcome and transfusion with hemoglobin level with cut-off point of 10 gr / dL OR 1,111 (p = 0.865 95% CI 0.328 - 3.755) Conclusion: A favorable or unfavorable association between the hemoglobin cut-off point and the functional neurological outcome was not demonstrated, it is not possible to make a recommendation against the transfusion threshold. No deleterious effect of blood transfusion was evident, no increase in episodes of spasm vessel or late cerebral ischemia. 2020-01-31 2020-02-14T20:31:20Z info:eu-repo/semantics/masterThesis info:eu-repo/semantics/acceptedVersion https://repository.urosario.edu.co/handle/10336/20883 spa Atribución-NoComercial-SinDerivadas 2.5 Colombia http://creativecommons.org/licenses/by-nc-nd/2.5/co/ info:eu-repo/semantics/openAccess application/pdf Universidad del Rosario Especialización en Medicina Crítica y Cuidado Intensivo Facultad de Medicina instname:Universidad del Rosario reponame:Repositorio Institucional EdocUR M. V, M. A. Subarachnoid hemorrhage: A neurological emergency. Open Crit Care Med J [Internet]. 2011;4:56–60. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=2011427138 Rosenberg NF, Koht A, Naidech AM. Anemia and transfusion after aneurysmal subarachnoid hemorrhage. J Neurosurg Anesth [Internet]. 2013;25(1):66–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23047622 Abulhasan YB, Alabdulraheem N, Simoneau G, Angle MR, Teitelbaum J. Mortality after Spontaneous Subarachnoid Hemorrhage: Causality and Validation of a Prediction Model. World Neurosurg [Internet]. 2018;112:e799–811. Available from: https://doi.org/10.1016/j.wneu.2018.01.160 Nassar HGE, Ghali AA, Bahnasy WS, Elawady MM. Vasospasm following aneurysmal subarachnoid hemorrhage: prediction, detection, and intervention. Egypt J Neurol Psychiatry Neurosurg. 2019;55(1) Zacharia BE, Hickman ZL, Grobelny BT, DeRosa P, Kotchetkov I, Ducruet AF, et al. Epidemiology of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 2010/04/13. 2010;21(2):221–33. Lelubre C, Bouzat P, Crippa IA, Taccone FS. Anemia management after acute brain injury. Crit Care [Internet]. 2016;20(1):1–11. Available from: http://dx.doi.org/10.1186/s13054-016-1321-6 Mejía C JA, Niño de Mejía MC, Ferrer Z LE, Cohen M D. Vasoespasmo cerebral secundario a hemorragia subaracnoidea por ruptura de aneurisma intracerebral. Rev Colomb Anestesiol [Internet]. 2007;35:143–62. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-33472007000200006&nrm=iso Lee Y, Zuckerman SL, Mocco J. Current Controversies in the Prediction, Diagnosis, and Management of Cerebral Vasospasm: Where Do We Stand? Neurol Res Int [Internet]. 2013;2013:373458. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817677/ Diringer MN, Zazulia AR. Aneurysmal Subarachnoid Hemorrhage: Strategies for Preventing Vasospasm in the Intensive Care Unit. Semin Respir Crit Care Med. 2017;38(6):760–7. de Oliveira Manoel AL, Goffi A, Marotta TR, Schweizer TA, Abrahamson S, Macdonald RL. The critical care management of poor-grade subarachnoid haemorrhage. Crit Care [Internet]. 2016;20(1):1–19. Available from: http://dx.doi.org/10.1186/s13054-016-1193-9 Naidech AM, Shaibani A, Garg RK, Duran IM, Liebling SM, Bassin SL, et al. Prospective, randomized trial of higher goal hemoglobin after subarachnoid hemorrhage. Neurocrit Care. 2010/08/19. 2010;13(3):313–20. Elterman J, Brasel K, Brown S, Bulger E, Christenson J, Kerby JD, et al. Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes. J Trauma Acute Care Surg. 2013;75(1):8–14. Kramer AH, Zygun DA, Bleck TP, Dumont AS, Kassell NF, Nathan B. Relationship between hemoglobin concentrations and outcomes across subgroups of patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care [Internet]. 2009;10. Available from: http://dx.doi.org/10.1007/s12028-008-9137-0 Kramer AH, Diringer MN, Suarez JI, Naidech AM, Macdonald LR, Le Roux PD. Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey. Crit Care [Internet]. 2011;15(1):1–11. Available from: http://dx.doi.org/10.1186/cc9977 Dhar R, Zazulia AR, Videen TO, Zipfel GJ, Derdeyn CP, Diringer MN. Red blood cell transfusion increases cerebral oxygen delivery in anemic patients with subarachnoid hemorrhage. Stroke [Internet]. 2009/07/25. 2009;40(9):3039–44. Available from: http://dx.doi.org/10.1161/STROKEAHA.109.556159 Festic E, Rabinstein AA, Freeman WD, Mauricio EA, Robinson MT, Mandrekar J, et al. Blood Transfusion is an Important Predictor of Hospital Mortality Among Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care [Internet]. 2013;18(2):209–15. Available from: http://dx.doi.org/10.1007/s12028-012-9777-y Kiser T. Cerebral Vasospasm in Critically Ill Patients with Aneurysmal Subarachnoid Hemorrhage: Does the Evidence Support the Ever-Growing List of Potential Pharmacotherapy Interventions? Hosp Pharm [Internet]. 2014;49(10):923–41. Available from: http://archive.hospital-pharmacy.com/doi/abs/10.1310/hpj4910-923 Yokose N, Sakatani K, Murata Y, Awano T, Igarashi T, Nakamura S, et al. Bedside monitoring of cerebral blood oxygenation and hemodynamics after aneurysmal subarachnoid hemorrhage by quantitative time-resolved near-infrared spectroscopy. World Neurosurg [Internet]. 2010;73(5):508–13. Available from: http://dx.doi.org/10.1016/j.wneu.2010.02.061 Chang TR, Naval NS, Carhuapoma JR. Controversies in Neurosciences Critical Care. Anesthesiol Clin [Internet]. 2012;30(2):369–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22901615 Broessner G, Lackner P, Hoefer C, Beer R, Helbok R, Grabmer C, et al. Influence of red blood cell transfusion on mortality and long-term functional outcome in 292 patients with spontaneous subarachnoid hemorrhage. Crit Care Med. 2009;37(6):1886–92. Kramer AH, Zygun DA. Anemia and red blood cell transfusion in neurocritical care. Crit Care [Internet]. 2009;13(3):R89. Available from: http://dx.doi.org/10.1186/cc7916 McLellan SA, Walsh TS. Oxygen delivery and haemoglobin. Contin Educ Anaesthesia, Crit Care Pain. 2004;4(4):123–6. OMS | Las 10 causas principales de defunción en el mundo. WHO [Internet]. 2014; Available from: http://www.who.int/mediacentre/factsheets/fs310/es/ Lantigua H, Ortega-Gutierrez S, Schmidt JM, Lee K, Badjatia N, Agarwal S, et al. Subarachnoid hemorrhage: who dies, and why? Crit Care [Internet]. 2015;19(1):309. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556224/ Turner CL, Budohoski K, Smith C, Hutchinson PJ, Kirkpatrick PJ. Elevated baseline C-reactive protein as a predictor of outcome after aneurysmal subarachnoid hemorrhage: Data from the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) trial. Neurosurgery. 2015;77(5):786–92. D’Souza S, D’Souza S. Aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol [Internet]. 2015;27(3):222–40. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463029/ Walsh TS, Lee RJ, Maciver CR, Garrioch M, Mackirdy F, Binning AR, et al. Anemia during and at discharge from intensive care: the impact of restrictive blood transfusion practice. Intensive Care Med. 2005/12/06. 2006;32(1):100–9. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med [Internet]. 1999;340. Available from: http://dx.doi.org/10.1056/NEJM199902113400601 Hebert PC, Wells G, Tweeddale M, Martin C, Marshall J, Pham B, et al. Does transfusion practice affect mortality in critically ill patients? Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials Group. Am J Respir Crit Care Med. 1997/05/01. 1997;155(5):1618–23. Prakash D. Anemia in the ICU: anemia of chronic disease versus anemia of acute illness. Crit Care Clin. 2012/06/21. 2012;28(3):333–43, v. Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J. Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. Bmj. 2015/03/26. 2015;350:h1354. Lelubre C, Vincent JL, Taccone FS. Red blood cell transfusion strategies in critically ill patients: lessons from recent randomized clinical studies. Minerva Anestesiol. 2016/01/13. 2016; Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med [Internet]. 2014/10/02. 2014;371(15):1381–91. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1406617 LeRoux P. Haemoglobin management in acute brain injury. Curr Opin Crit Care [Internet]. 2013;19(2). Available from: http://journals.lww.com/co-criticalcare/Fulltext/2013/04000/Haemoglobin_management_in_acute_brain_injury.4.aspx English SW, Chasse M, Turgeon AF, Tinmouth A, Boutin A, Pagliarello G, et al. Red blood cell transfusion and mortality effect in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis protocol. Syst Rev [Internet]. 2015;4:41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25927348 Bell DL, Kimberly WT, Yoo AJ, Leslie-Mazwi TM, Rabinov JD, Bell JE, et al. Low neurologic intensive care unit hemoglobin as a predictor for intra-arterial vasospasm therapy and poor discharge modified Rankin Scale in aneurysmal subarachnoid haemorrhage-induced cerebral vasospasm. J Neurointerv Surg [Internet]. 2015;7(6):438–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24814068 Kurtz P, Schmidt JM, Claassen J, Carrera E, Fernandez L, Helbok R, et al. Anemia is associated with metabolic distress and brain tissue hypoxia after subarachnoid hemorrhage. Neurocrit Care [Internet]. 2010;13(1):10–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20383611 Oddo M, Milby A, Chen I, Frangos S, MacMurtrie E, Maloney-Wilensky E, et al. Hemoglobin concentration and cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage. Stroke [Internet]. 2009 Apr [cited 2016 Oct 1];40(4):1275–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19265059 Taccone FS, Citerio G, Le Roux P, Menon DK, Vespa P, Bader MK, et al. Advanced Monitoring of Systemic Hemodynamics in Critically Ill Patients with Acute Brain Injury. Neurocrit Care [Internet]. 2014/09/12. 2014;21(S2):38–63. Available from: http://link.springer.com/10.1007/s12028-014-0033-5 Le Roux PD. Anemia and transfusion after subarachnoid hemorrhage. Neurocrit Care [Internet]. 2011;15(2):342–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21769459 Hao Z, Wu B, Wang D, Lin S, Tao W, Liu M. A cohort study of patients with anemia on admission and fatality after acute ischemic stroke. J Clin Neurosci [Internet]. 2013;20(1):37–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23117142 Sampson TR, Dhar R, Diringer MN. Factors associated with the development of anemia after subarachnoid hemorrhage. Neurocrit Care [Internet]. 2009/09/25. 2010;12(1):4–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19777386 Fergusson D, Montroy K, Pagliarello G, Griesdale D, Chassé M, Garland A, et al. Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: Results of a multicenter cohort study. Crit Care. 2018;22(1):1–9. Naidech AM, Jovanovic B, Wartenberg KE, Parra A, Ostapkovich N, Connolly ES, et al. Higher hemoglobin is associated with improved outcome after subarachnoid hemorrhage. Crit Care Med [Internet]. 2007;35(10):2383–9. Available from: http://dx.doi.org/10.1097/01.CCM.0000284516.17580.2C Organization WH. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitam Miner Nutr Inf Syst. 2011;WHO/NMH/NH(World Health Organization):6. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: A systematic review of the literature. Crit Care Med. 2008/08/06. 2008;36(9):2667–74. Kshettry VR, Rosenbaum BP, Seicean A, Kelly ML, Schiltz NK, Weil RJ. Incidence and risk factors associated with in-hospital venous thromboembolism after aneurysmal subarachnoid hemorrhage. J Clin Neurosci [Internet]. 2014;21(2):282–6. Available from: http://dx.doi.org/10.1016/j.jocn.2013.07.003 Etminan N. Aneurysmal subarachnoid hemorrhage--status quo and perspective. Transl Stroke Res. 2015/04/11. 2015;6(3):167–70. Ayling OGS, Ibrahim GM, Alotaibi NM, Gooderham PA, Macdonald RL. Anemia After Aneurysmal Subarachnoid Hemorrhage Is Associated With Poor Outcome and Death. Stroke. 2018;49(8):1859–65. de Rooij NK, Rinkel GJE, Dankbaar JW, Frijns CJM. Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Systematic Review of Clinical, Laboratory, and Radiological Predictors. Stroke [Internet]. 2012;43–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23250997 Inagawa T. Risk Factors for Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage: A Review of the Literature. World Neurosurg [Internet]. 2016;85:56–76. Available from: http://dx.doi.org/10.1016/j.wneu.2015.08.052 Dasenbrock HH, Rudy RF, Lai PMR, Smith TR, Frerichs KU, Gormley WB, et al. Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: A nationwide analysis. J Neurosurg. 2018;129(2):446–57. Kumar G, Shahripour RB, Harrigan MR. Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2015;124(May):1257–64. Wartenberg KE, Schmidt JMM, Claassen J, Temes RE, Frontera JA, Ostapkovich N, et al. Impact of medical complications on outcome after subarachnoid hemorrhage*. Crit Care Med [Internet]. 2006;34(3). Available from: http://dx.doi.org/10.1097/00003246-200612002-00426 |
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