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Impacto do timing entre diagnóstico e o tratamento na hemorragia subaracnóidea de causa aneurismática e comparação entre as complicações nos doentes intervencionados via clipping cirúrgico vs coiling endovascular
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Introdução: Das causas não traumáticas de hemorragia aguda para o espaço subaracnoideu, a hemorragia subaracnóidea de causa aneurismática (HSAa) é a forma mais comum (85%) e mais grave onde 33 a 50% dos sobreviventes apresentam sequelas a longa prazo, entre 20 a 51% não sobrevivem e cerca de 26% morrem antes de chegar ao hospital. As abordagens preconizadas no tratamento são o clipping cirúrgico e a embolização endovascular.
Objetivo: Avaliar a relação e impacto do tempo entre o diagnóstico e tratamento, bem como as complicações e resultados na população de doentes internados no Serviço de Medicina Intensiva - Unidade Neurocrítica da Unidade Local de Saúde(ULS) de Santa Maria, entre 2017 e 2023, após intervenção cirúrgica ou endovascular.
Metodologia: Os dados foram recolhidos a partir de uma base de dados Excel, criada pelo próprio serviço. Adicionalmente foram recolhidas informações clínicas dos softwares informáticos de apoio Alert, EPR e PICIS.
Resultados: Incluídos 200 doentes. A idade média foi 58,1 anos (dp=13,62), 71% do sexo feminino e maior incidência de aneurismas na circulação anterior. À admissão 41% dos doentes tinham WFNS 4-5, 26% Hunt and Hess 4-5 e 82% um mFisher de 4-5.O tempo médio entre admissão e tratamento foram 17,8h (16,7h clipping e 17,8h coiling). A duração média de internamento no SMI foram 14,4 dias. Da população 59% (118) dos doentes foram submetidos a clipping e 41% (82) a embolização endovascular. O grupo endovascular demostrou-se mais velho (61,3 anos) que o clipping (55,9 anos) e com maior prevalência de aneurismas da circulação posterior. O clipping teve maior incidência de Vasoespamo Ligeiro (28,8%) e o coiling necessidade de ventilação invasiva (61%). Nos outcomes destaca-se no tratamento endovascular GSO (18,3% I-Dead) e óbito (18.3%) à saída do SMI e à alta hospitalar (24%) superiores ao clipping.
Conclusões: Não foram observadas diferenças significativas no tempo entre a admissão e o tratamento nem este se mostrou associado à sobrevivência dos doentes em nenhuma das duas técnicas utilizadas na população estudada. No entanto, o tipo de tratamento mostrou-se significativamente associado à sobrevivência.
Introduction: Among non-traumatic causes of acute hemorrhage to the subarachnoid space, aneurysmal subarachnoid hemorrhage (aSAH) is the most common (85%) and severe form with 33% to 50% of its survivors experiencing long-term sequels, 20% to 51% don’t survive, and approximately 26% die before reaching the hospital. The recommended treatment approaches are surgical clipping and endovascular embolization. Objective: Evaluate the role of the timing between diagnosis and treatment, as well as complications and outcomes, on the patient population admitted to the Intensive Care Unit - Neurocritical Care Unit of the Local Health Unit (ULS) of Santa Maria, between 2017 and 2023, following surgical or endovascular intervention. Methodology: Data were collected from an Excel database created by the ICU unit. Additionally, clinical information was gathered from the supporting computer software Alert, EPR, and PICIS. Results: A total of 200 patients were included. The mean age was 58.1 years (SD=13.62), 71% female and a higher incidence of aneurysms in the anterior circulation. Upon admission, 41% of the patients had a WFNS score of 4-5, 26% had a Hunt and Hess score of 4-5, and 82% had an mFisher score of 4-5. The mean time between admission and treatment was 17.8 hours (16.7 hours for clipping and 17.8 hours for coiling). The average duration of ICU stay was 14.4 days. Of the population 59% (118 patients) were subjected to clipping and 41% (82 patients) embolization. The endovascular group was older (mean 61.3 years) compared to the clipping group (mean 55.9 years) and had a higher prevalence of posterior circulation aneurysms. Clipping had a higher incidence of mild vasospasm (28.8%), while coiling had a higher need for invasive ventilation (61%). The endovascular group showed a higher GSO I-Dead (18.3%) and a mortality rate of 18.3% and 24% at ICU and hospital discharge. Conclusions: No statistical differences were found in the time between admission and treatment, nor we found any statistical association with patient survival. However, the modality of treatment had an impact on patient outcomes.
Introduction: Among non-traumatic causes of acute hemorrhage to the subarachnoid space, aneurysmal subarachnoid hemorrhage (aSAH) is the most common (85%) and severe form with 33% to 50% of its survivors experiencing long-term sequels, 20% to 51% don’t survive, and approximately 26% die before reaching the hospital. The recommended treatment approaches are surgical clipping and endovascular embolization. Objective: Evaluate the role of the timing between diagnosis and treatment, as well as complications and outcomes, on the patient population admitted to the Intensive Care Unit - Neurocritical Care Unit of the Local Health Unit (ULS) of Santa Maria, between 2017 and 2023, following surgical or endovascular intervention. Methodology: Data were collected from an Excel database created by the ICU unit. Additionally, clinical information was gathered from the supporting computer software Alert, EPR, and PICIS. Results: A total of 200 patients were included. The mean age was 58.1 years (SD=13.62), 71% female and a higher incidence of aneurysms in the anterior circulation. Upon admission, 41% of the patients had a WFNS score of 4-5, 26% had a Hunt and Hess score of 4-5, and 82% had an mFisher score of 4-5. The mean time between admission and treatment was 17.8 hours (16.7 hours for clipping and 17.8 hours for coiling). The average duration of ICU stay was 14.4 days. Of the population 59% (118 patients) were subjected to clipping and 41% (82 patients) embolization. The endovascular group was older (mean 61.3 years) compared to the clipping group (mean 55.9 years) and had a higher prevalence of posterior circulation aneurysms. Clipping had a higher incidence of mild vasospasm (28.8%), while coiling had a higher need for invasive ventilation (61%). The endovascular group showed a higher GSO I-Dead (18.3%) and a mortality rate of 18.3% and 24% at ICU and hospital discharge. Conclusions: No statistical differences were found in the time between admission and treatment, nor we found any statistical association with patient survival. However, the modality of treatment had an impact on patient outcomes.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Hemorragia subaracnóideia aneurismática (HSAa) Timing Tratamento