gms | German Medical Science

Objective: Blood pressure management in patients with severe subarachnoid hemorrhage (SAH) and refractory hypertensive therapy is demanding and may require the careful use of additional drugs to elevate mean arterial pressure (>110 mmHG) during cerebral vasospasm (CVS) time. The aim of the present study is to determine the benefits and side effects of vasopressin in the treatment of cerebral vasospasm in SAH patients.

Methods: We retrospectively evaluated 13 patients with aneurysmal SAH and cerebral vasospasm (CVS) who received vasopressin infusion for blood pressure support. Patients were admitted to our neurosurgical department between 2017 and 2018. We assessed the daily dose of vasopressin and norepinephrine within the first 15 days after admission. Serum sodium concentration, the incidence of diabetes insipidus and cerebral infarction and the final outcome were recorded.

Results: A total of 13 patients were included. In seven patients (53.8%) a H/H grade 4 and 5 SAH were found and in 6 patients (46.2%) a Fisher 4 bleeding. Severe CVS occured in 8 patients (61.5%). The daily dose of vasopressin was between 1.2 IU/min to 64.9IU/min. The mean duration of application was 5 days (range 2 to 10 days). In 11 patients (84.6%), a reduction in norepinephrine dose more than 50% compared to the initial dose was achieved after starting with vasopressin infusion. Two patients (15.4%) required a high dosis of noepinephrine and vasopressin to elevate the mean arterial pressure. Dobutamine was used in 3 patients for additional blood pressure support. No patient had hyponatremia. We found cerebral infarction (CI) in 7 patients (53.8%). The amount of the mean total dose of vasopressin did not affect the incidence of CI (p>0.29). Four patients (30.8%) showed a favorable outcome. Outcome correlated significantly with first admission state (p<0.01).

Conclusion: The use of vasopressin infusion leads to a reduction of catecholamine doses in the blood pressure management without negative side effect such as hyponatremia and may consider for additional blood pressure support in SAH patients with a refractory catecholamine treatment.