Effect of Circadian Biology on Subarachnoid Hemorrhage Onset, Intervention, and Outcome in ICU: A Narrative Review
Notice bibliographique
Résumé
Abstract Rationale: Subarachnoid hemorrhages (SAH) are a life-threatening accumulation of blood between the arachnoid and pia mater. The incidence of SAH in the United States is between 10 and 14 out of 100,000 individuals per year, carrying a high risk of death and disability. Impaired sleep and circadian disruption lead to increased mortality and long-term morbidity in patients admitted to an intensive care unit (ICU). We performed a scoping review to explore the impact of circadian rhythms on SAH outcomes including rupture time, intervention time, incidence of delayed cerebral ischemia, circadian biology specific variables (i.e., melatonin levels, patient-reported sleep quality, temperature), and circadian entrainment. We aimed to identify gaps and whether there is a relationship between circadian rhythm and timing of management of a ruptured aneurysm, circadian biology, and patient-centered short- (e.g., delirium) and long-term (e.g., Glasgow outcome score) outcomes. Methods: A comprehensive search across multiple databases was completed on 26 July 2024 with the aid of a medical librarian. The search strategy focused on identifying English-language literature related to circadian rhythm interventions in critical care patients admitted with the primary diagnosis of SAH. Study selection and data extraction were independently verified. Results: Of the 881 unique articles identified, 25 studies met inclusion criteria. Sixteen articles explored diurnal patterns of the timing of aneurysm rupture. Of the included studies, the following circadian specific variables were studied: cortisol concentration (n=4), temperature (n=1), melatonin concentration (n=2), and gene expression (n=1). The effect of intervention timing (day vs night) on patient outcomes was studied in 2 articles. There was a consistent diurnal pattern of aneurysm rupture characterized by a morning peak, secondary evening peak, and nighttime trough, regardless of risk factors and sub-group analysis. Preliminary results demonstrate abnormal diurnal cortisol concentration profiles in SAH patients, correlated with continuous sedation and need for mechanical ventilation. Few studies evaluated the association between circadian specific variables, timing of SAH treatment (i.e., coiling or clipping of the aneurysm), and patient outcomes. Of the two that did, findings were mixed. Conclusion: Important gaps in the existing literature on the role of circadian biology in patients admitted to an ICU with SAH were identified. Despite finding a diurnal pattern of aneurysm rupture, further research is needed to understand the influence of circadian biology on management (e.g., timing of coiling) and related complications (e.g., delayed cerebral ischemia).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,002 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».