To determine the association of individualized autoregulation-based blood pressure (BP) targets on delayed cerebral ischemia (DCI) and functional outcome in patients with aSAH.

Optimal BP targets in the first days after aSAH, prior to the development of vasospasm or DCI, are not well established. Autoregulation-oriented BP management is a plausible strategy to provide optimal physiologic support for the acutely injured brain.

We prospectively enrolled 11 patients with aSAH undergoing multimodality neuromonitoring. Autoregulation was continuously measured by interrogating changes in near-infrared spectroscopy-derived tissue oxygenation and arterial BP. Using the resulting autoregulatory index, we produced time trends of BP at which autoregulation was optimally preserved (MAPopt), together with upper and lower limits of autoregulation. Percent time outside limits of autoregulation (LA) was computed for each patient. Ordinal regression was used to assess the relationship between BP deviation from LA or MAPopt (?MAPopt) and discharge modified Rankin Scale (mRS). Patients with and without DCI, as defined by infarction on CT/MRI, were compared using non-parametric statistics.

Identification of MAPopt was possible in all patients (age 54.9±15, 7 female, Hunt-Hess 2.7±1, modified Fisher 3.1±1) with an average monitoring time of 58.8h. MAPopt was calculated for 84.7±6% of the total monitoring period. Median time spent within optimal BP range was 56.1%, and both percent time outside LA and ?MAPopt were associated with worse outcomes (p=0.02 and p=0.03, respectively), adjusting for age, sex, HH, and mF. Every additional 10% time spent outside LA conferred a 3-fold likelihood of a worse discharge mRS. In comparing patients with DCI to those without, there was a significant increase in percent time outside LA (61.5% vs. 19.9%, p=0.02).

Calculation of personalized autoregulation-based BP targets after aSAH is feasible; BP management outside LA may increase the risk for DCI and worse functional outcomes.