gms | German Medical Science

Objective: Nimodipine was shown to improve clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH). International guidelines include oral administration of 60 mg nimodipine every 40 hours. However, an association between nimodipine administration and a decrease in mean arterial pressure (MAP) is declared and clinical routine may imply discontinuation or dose reduction of the drug to anticipate this effect in certain patients. To evaluate how many patients receive the full dosage of nimodipine in clinical reality we designed this retrospective study.

Method: The clinical course of patients suffering from aSAH from 2009 to 2013 was analyzed retrospectively. Nimodipine was reduced in dosage by 50 % or discontinued if a severe reduction of MAP occurred after application and/or a high dosage of catecholamines (>0.4 ug/min/kg) was required to maintain sufficient MAP.

Results: 240 patients were admitted to our intensive care unit after aSAH (71 % female, 29 % male). Nimodipine was not administered in 20 % of patients due to a bad prognosis, e.g. fixed and dilated pupils or cardiopulmonary rescuscitation before admission. Nimodipine had to be discontinued in 23 % of patients and reduced in dosage in 22 % of the patients. Only 35 % received oral nimodipine without discontinuation or dosage reduction during the first 14 days after aSAH. The amount of patients receiving full dosage of nimodipine negatively correlated with Hunt and Hess grades (I°: 56 %, II°: 44 %, III°: 40 %, IV°: 26 %, V°: 10%, p<0.0001).

Conclusions: Our data show that nimodipine was fully administered in only 35 % of patients suffering from aSAH despite the intention to treat 80 % of the patients. This reflects a severe difference between the number of patients we intended to treat with nimodipine and the reality in clinical routine. In patients with Hunt and Hess grades IV° and V°, who are at highest risk of vasospasm, the actual admission of nimopidine was the lowest.