Incremental Versus Immediate Induction of Hypertension in the Treatment of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage.
Delayed cerebral infarction
Delayed cerebral ischemia
Induced hypertension
Subarachnoid hemorrhage
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
10
11
2021
accepted:
14
01
2022
pubmed:
10
3
2022
medline:
20
5
2022
entrez:
9
3
2022
Statut:
ppublish
Résumé
Delayed cerebral ischemia (DCI) is a common complication of aneurysmal subarachnoid hemorrhage and contributes to unfavorable outcome. In patients with deterioration despite prophylactic nimodipine treatment, induced hypertension (iHTN) can be considered, although the safety and efficacy of induction are still a matter of debate. In this study, two iHTN treatment algorithms were compared with different approaches toward setting pressure targets. In a cohort of 325 consecutive patients with subarachnoid hemorrhage, 139 patients were treated by induced hypertension as a first tier treatment. On diagnosing DCI, blood pressure was raised via norepinephrine infusion in 20-mm Hg increments in 37 patients (iHTN The rate of refractory DCI requiring additional rescue therapy was comparable in both groups (48.9% in iHTN Immediate induction of hypertension with higher pressure targets did not result in a lower rate of DCI-related infarctions but was not associated with a higher complication rate compared with an incremental approach. Future tailored blood pressure management based on patient- and time-point-specific needs will hopefully better balance the neurological advantages versus the systemic complications of induced hypertension.
Sections du résumé
BACKGROUND
Delayed cerebral ischemia (DCI) is a common complication of aneurysmal subarachnoid hemorrhage and contributes to unfavorable outcome. In patients with deterioration despite prophylactic nimodipine treatment, induced hypertension (iHTN) can be considered, although the safety and efficacy of induction are still a matter of debate. In this study, two iHTN treatment algorithms were compared with different approaches toward setting pressure targets.
METHODS
In a cohort of 325 consecutive patients with subarachnoid hemorrhage, 139 patients were treated by induced hypertension as a first tier treatment. On diagnosing DCI, blood pressure was raised via norepinephrine infusion in 20-mm Hg increments in 37 patients (iHTN
RESULTS
The rate of refractory DCI requiring additional rescue therapy was comparable in both groups (48.9% in iHTN
CONCLUSIONS
Immediate induction of hypertension with higher pressure targets did not result in a lower rate of DCI-related infarctions but was not associated with a higher complication rate compared with an incremental approach. Future tailored blood pressure management based on patient- and time-point-specific needs will hopefully better balance the neurological advantages versus the systemic complications of induced hypertension.
Identifiants
pubmed: 35260962
doi: 10.1007/s12028-022-01466-7
pii: 10.1007/s12028-022-01466-7
pmc: PMC9110507
doi:
Substances chimiques
Vasoconstrictor Agents
0
Banques de données
ClinicalTrials.gov
['NCT02142166']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
702-714Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. The Author(s).
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