Up to this day, little is known whether the extent of brain damage in patients with SAH correlates with the degree neurogenic myocardial injury and neurogenic lung injury. This is a prospective observational study designed to asses relationship between catecholamine surge and development of myocardial and lung injury in subarachnoid haemorrhage patients.
Multiple forms of brain damage, primarily, subarachnoid haemorrhage (SAH) are frequently accompanied by neurogenic myocardial injury with changes in the electrocardiogram, accompanied by the release of markers of myocardial injury. This form of cardiac dysfunction is thought to be mediated by cellular toxicity associated with catecholamine release. Central nervous system damage in the course of intracranial haemorrhage may, in a similar pathogenic pathway, lead to neurogenic lung injury. Up to this day, little is known whether the extent of brain damage in patients with SAH correlates with the degree of neurogenic myocardial injury. Moreover, it remains unknown what is the full clinical picture and duration of this type of myocardial injury and how often it co-occurs with neurogenic lung injury. Such analysis is a fundamental and most important step in optimising the treatment of these patients. Methods: In this prospective observational study the authors aim to recruit 30 patients with subarachnoid haemorrhage, requiring hospitalization in the Intensive Care Unit. The patients will be monitored for elevation in cardiac damage markers (hs-TnT, CPK, CK-MB, NT-proBNP) and worsening of respiratory conditions, defined by need for more invasive ventilation parameters, and subsequent changes in arterial blood gas. The above mentioned parameters will be assessed every 12 hours. Additionally, the patients will be screened for an elevation in catecholamine metabolite (metanephrine) concentration in 12-hour urine collection. Hypothesis to be tested: Myocardial and lung injury in SAH patients is timely-associated with an increase in metanephrine concentration in urine.
Study Type
OBSERVATIONAL
Enrollment
30
hs-TnT plasma concentration measured once every 12 hours
CK-MB plasma concentration measured every 12 hours
CPK plasma concentration measured every 12 hours
University Clinical Center prof. K. Gibiński of the Medical University of Silesia in Katowice
Katowice, Silesian Voivodeship, Poland
RECRUITINGIn-hospital death (number of patients)
Death of the patient during the first 7 days of hospitalization.
Time frame: 7 days
Number of Patients with elevation in hs-TnT levels
hs-TnT treated as myocardial injury biomarker
Time frame: 7 days
Number of Patients with elevation in NT-proBNP levels
NT-proBNP treated as myocardial injury biomarker
Time frame: 7 days
Number of Patients with elevation in creatine kinase levels
Creatine kinase treated as myocardial injury biomarker
Time frame: 7 days
Number of Patients with elevation in creatine kinase MB levels
Creatine kinase MB treated as myocardial injury biomarker
Time frame: 7 days
Number of Patients with a decrease in Horowitz index
The decrease in Horowitz index treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
Time frame: 7 days
Number of Patients with need of increased FiO2
Need of increased FiO2 treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
Time frame: 7 days
Number of Patients with need of increased PEEP values
Need of increased PEEP values treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
Time frame: 7 days
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NT-proBNP plasma concentration measured every 12 hours
Metanephrine concentration measured in 12-hour urine collection using spectrophotometry.
Number of Patients with need for the use of neuro-muscular blocking agents
Need for the use of neuro-muscular blocking agents treated as a sign of need for more invasive ventilation parameters with subsequent blood gas changes
Time frame: 7 days