{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:43:18Z","timestamp":1792806198502,"version":"4.5.0"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Recent guidelines recommend targeting a systolic blood pressure (SBP) < 140 mm Hg in the early management of patients with spontaneous intracerebral hemorrhage (ICH). The optimal SBP targets for ICH patients after hematoma evacuation (HE) remain unclear. Here, the authors aimed to define the optimal SBP range based on multimodal neuromonitoring data.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n Forty poor-grade ICH patients who had undergone HE and then monitoring of intracerebral pressure, brain tissue oxygen tension (P\n bt<\/jats:sub>\n O\n 2<\/jats:sub>\n ), and cerebral metabolism (via cerebral microdialysis [CMD]) were prospectively included. Episodes of brain tissue hypoxia (BTH) (1-hour averaged P\n bt<\/jats:sub>\n O\n 2<\/jats:sub>\n < 20 mm Hg) and metabolic distress (CMD\u2013lactate\/pyruvate ratio [LPR] \u2265 40) were identified and linked to corresponding parameters of hemodynamic monitoring (SBP and cerebral perfusion pressure [CPP]). Multivariable regression analysis was performed using generalized estimating equations to identify associations between SBP levels, P\n bt<\/jats:sub>\n O\n 2<\/jats:sub>\n , and brain metabolism.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The mean patient age was 60 (range 51\u201366) years and the median [IQR] initial ICH volume was 47 [29\u201360] ml. In multivariable models adjusted for Glasgow Coma Scale score, probe location, ICH volume, and age, lower SBP was independently associated with a higher risk of BTH (\u2264 120 mm Hg: adjusted OR 2.9, p = 0.007; 120\u2013130 mm Hg: adj OR 2.4, p = 0.002; 130\u2013140 mm Hg: adj OR 1.6, p = 0.017) compared to a reference range of 140\u2013150 mm Hg at the level of the foramen interventriculare Monroi, which corresponded to a CPP of 70\u201380 mm Hg and SBP levels between 150 and 160 mm Hg at the heart level. After exclusion of episodes with mitochondrial dysfunction, SBP targets < 140 mm Hg were associated with higher odds of cerebral metabolic distress (\u2264 130 mm Hg: OR 2.5, p = 0.041; 130\u2013140 mm Hg: OR 2.3, p = 0.033). Patients with a modified Rankin Scale score \u2265 5 at neurological ICU discharge more often exhibited BTH than patients with better outcomes (51% vs 10%, p = 0.003).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n These data suggest that lower SPB and CPP levels are associated with a higher risk for BTH. Further studies are needed to evaluate whether a higher SPB target may prevent BTH and improve outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2020.9.jns201024","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T04:04:13Z","timestamp":1617941053000},"page":"1656-1665","source":"Crossref","is-referenced-by-count":11,"title":["Individualized blood pressure targets in the postoperative care of patients with intracerebral hemorrhage"],"prefix":"10.3171","volume":"135","author":[{"given":"Anna","family":"Lindner","sequence":"first","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Rass","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan-Andrei","family":"Ianosi","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"},{"name":"Institute of Medical Informatics, UMIT: University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alois Josef","family":"Schiefecker","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Kofler","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Gaasch","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Addis","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Rhomberg","sequence":"additional","affiliation":[{"name":"Departments of Neuroradiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Pfausler","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronny","family":"Beer","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erich","family":"Schmutzhard","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudius","family":"Thom\u00e9","sequence":"additional","affiliation":[{"name":"Neurosurgery, Medical University of Innsbruck;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimund","family":"Helbok","sequence":"additional","affiliation":[{"name":"Neurological Intensive Care Unit, Department of Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Am J Emerg Med","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.ajem.2006.07.008","article-title":"Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States","volume":"25","author":"Qureshi AI","year":"2007","unstructured":"Qureshi AI, Ezzeddine MA, Nasar A, Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. 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