BACKGROUND: Nimodipine is the only medication shown to improve outcomes after aneurysmal subarachnoid hemorrhage (SAH). Preliminary theories regarding the mechanism by which it prevents vasospasm have been challenged. The acute physiologic and metabolic effects of oral Nimodipine have not been examined in patients with poor-grade SAH. METHODS: This is an observational study performed in 16 poor-grade SAH patients undergoing multimodality monitoring who received oral Nimodipine as part of routine clinical care. A total of 663 doses of Nimodipine were observed. Changes in physiologic measurements including MAP, CPP, ICP, P(bt)O(2), and CBF were examined. RESULTS: Administration of oral Nimodipine was associated with a 1.33 mmHg decrease in MAP (P < 0.001) and a 1.22 mmHg decrease in CPP (P < 0.001). When administration of Nimodipine was associated with MAP decreases, P(bt)O(2) (1.03 mmHg; P < 0.001) and CBF (0.39 ml/100 g/min; P = 0.002) also decreased. CONCLUSIONS: Despite CPP targeted therapy with vasopressor medication, oral Nimodipine was associated with a decrease in MAP and CPP. When Nimodipine administration was associated with a decrease in MAP, there were concomitant drops in P(bt)O(2) and CBF. These findings suggest that MAP support after oral Nimodipine may be important to maintain adequate CBF in patients with poor-grade subarachnoid hemorrhage.
BACKGROUND:Nimodipine is the only medication shown to improve outcomes after aneurysmal subarachnoid hemorrhage (SAH). Preliminary theories regarding the mechanism by which it prevents vasospasm have been challenged. The acute physiologic and metabolic effects of oral Nimodipine have not been examined in patients with poor-grade SAH. METHODS: This is an observational study performed in 16 poor-grade SAHpatients undergoing multimodality monitoring who received oral Nimodipine as part of routine clinical care. A total of 663 doses of Nimodipine were observed. Changes in physiologic measurements including MAP, CPP, ICP, P(bt)O(2), and CBF were examined. RESULTS: Administration of oral Nimodipine was associated with a 1.33 mmHg decrease in MAP (P < 0.001) and a 1.22 mmHg decrease in CPP (P < 0.001). When administration of Nimodipine was associated with MAP decreases, P(bt)O(2) (1.03 mmHg; P < 0.001) and CBF (0.39 ml/100 g/min; P = 0.002) also decreased. CONCLUSIONS: Despite CPP targeted therapy with vasopressor medication, oral Nimodipine was associated with a decrease in MAP and CPP. When Nimodipine administration was associated with a decrease in MAP, there were concomitant drops in P(bt)O(2) and CBF. These findings suggest that MAP support after oral Nimodipine may be important to maintain adequate CBF in patients with poor-grade subarachnoid hemorrhage.
Authors: J Michael Schmidt; Sang-Bae Ko; Raimund Helbok; Pedro Kurtz; R Morgan Stuart; Mary Presciutti; Luis Fernandez; Kiwon Lee; Neeraj Badjatia; E Sander Connolly; Jan Claassen; Stephan A Mayer Journal: Stroke Date: 2011-03-24 Impact factor: 7.914
Authors: Raimund Helbok; Ravi Chandra Madineni; Michael J Schmidt; Pedro Kurtz; Luis Fernandez; Sang-Bae Ko; Alex Choi; Morgan R Stuart; E Sander Connolly; Kiwon Lee; Neeraj Badjatia; Stephan A Mayer; Alexander G Khandji; Jan Claassen Journal: Neurocrit Care Date: 2011-04 Impact factor: 3.210
Authors: Michael F Stiefel; Gregory G Heuer; John M Abrahams; Stephanie Bloom; Michelle J Smith; Eileen Maloney-Wilensky; M Sean Grady; Peter D LeRoux Journal: J Neurosurg Date: 2004-10 Impact factor: 5.115
Authors: K C Petruk; M West; G Mohr; B K Weir; B G Benoit; F Gentili; L B Disney; M I Khan; M Grace; R O Holness Journal: J Neurosurg Date: 1988-04 Impact factor: 5.115
Authors: S M Dorhout Mees; G J E Rinkel; V L Feigin; A Algra; W M van den Bergh; M Vermeulen; J van Gijn Journal: Cochrane Database Syst Rev Date: 2007-07-18
Authors: Luzius A Steiner; Marek Czosnyka; Stefan K Piechnik; Piotr Smielewski; Doris Chatfield; David K Menon; John D Pickard Journal: Crit Care Med Date: 2002-04 Impact factor: 7.598
Authors: Rajat Dhar; Chad Washington; Michael Diringer; Allyson Zazulia; Hussain Jafri; Colin Derdeyn; Gregory Zipfel Journal: Neurocrit Care Date: 2016-10 Impact factor: 3.210
Authors: Martin Kieninger; Michael Gruber; Isabella Knott; Katja Dettmer; Peter J Oefner; Sylvia Bele; Christina Wendl; Simon Tuemmler; Bernhard Graf; Christoph Eissnert Journal: Neurocrit Care Date: 2019-08 Impact factor: 3.210
Authors: Airton Leonardo de Oliveira Manoel; Alberto Goffi; Tom R Marotta; Tom A Schweizer; Simon Abrahamson; R Loch Macdonald Journal: Crit Care Date: 2016-01-23 Impact factor: 9.097