Artikel
High-dose norepinephrine may increase the risk of delayed cerebral ischemia in patients with aneurysmal subarachnoid haemorrhage – a single-centre retrospective evaluation
Hochdosiertes Noradrenalin kann das Risiko einer verzögerten zerebralen Ischämie bei Patienten mit aneurysmatischer Subarachnoidalblutung erhöhen: eine retrospektive Auswertung eines einzelnen Zentrums
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Autoren
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Andrea Cattaneo
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Christoph Wipplinger
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Caroline Geske
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Florian Semmler
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Tamara Wipplinger
- Columbia University, Department of Biobehavioral Sciences, Teachers College, New York, NY, Vereinigte Staaten
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Judith Weiland
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Alexandra Beez
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Thomas Linsenmann
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Ralf-Ingo Ernestus
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Ekkehard Kunze
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
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Christian Stetter
- Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Although extensive research on potential causes of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients has been conducted, the underlying mechanism remains incompletely understood. Sedated patients may require high doses of norepinephrine to maintain a certain mean arterial pressure (MAP). However, the administration of high doses has been associated with severe end organ damage. Despite of this, literature on the effects on cerebral microvasculature is scarce. With this study, we aimed to investigate the effects of norepinephrine on the incidence of DCI in a clinical setting.
Methods: We conducted a retrospective evaluation in patients with aSAH admitted to our institution. We analyzed potential risk factors for DCI while a prophylactic MAP of 90mmHg was maintained. Significant predictors were included into a logistic regression analysis to account for potential confounders. In addition to this, significant predictors for poor outcome (modified rankin scale 3 – 6) were analyzed.
Results: A total of 104 patients was included in this analysis. Hereof, 57 patients (55%) showed radiographic signs of DCI between day three and 14 post-intervention. Patients with DCI had more frequent vasospasms (n = 47 vs. 23, p = 0.005), a higher Hunt & Hess score (3 ± 2 vs. 2 ± 1, p = 0.004), a lower initial GCS (9 ± 5 vs. 12 ± 4, p = 0.003) and received a higher median norepinephrine dose (21,000µg vs. 5,000µg, p < 0.001). A logistic regression analysis revealed that only high-dose norepinephrine administration (OR 2.96, CI 1.18 – 7.4) and angiographic vasospasm (OR 3.07, CI 1.2 – 7.84) appeared to be independent risk factors for DCI. When analyzing predictors for poor outcome in our sample, only DCI was an independent risk factor (OR 9.35, CI 2.26 – 38.71).
Conclusion: Our results indicate a significant association between higher dose norepinephrine administration and the occurrence of DCI. Future research including greater sample sizes will be necessary to further investigate the relationship.
