Karim Lakhal, Marion H Fresco, Antoine Hivert, Bertrand Rozec, Julien Cadiet
{"title":"蛛网膜下腔出血后的脑血管痉挛：诱导性动脉高压及其与静脉注射米力农联合应用的短期效应：经颅多普勒超声概念验证研究。","authors":"Karim Lakhal, Marion H Fresco, Antoine Hivert, Bertrand Rozec, Julien Cadiet","doi":"10.1097/CCE.0000000000000973","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>It is unclear whether IV milrinone relaxes spasmed cerebral arteries and therefore reduces cerebral blood mean velocity (V<sub>mean</sub>). In patients treated for cerebral vasospasm, we aimed to assess and delineate the respective impacts of induced hypertension and its combination with IV milrinone on cerebral hemodynamics as assessed with transcranial Doppler.</p><p><strong>Design: </strong>Observational proof-of-concept prospective study.</p><p><strong>Setting: </strong>ICU in a French tertiary care center.</p><p><strong>Patients: </strong>Patients with aneurysmal subarachnoid hemorrhage who received induced hypertension (mean arterial blood pressure [MBP] of 100-120 mm Hg) and IV milrinone (0.5 µg/kg/min) for moderate-to-severe cerebral vasospasm. We excluded patients who underwent invasive angioplasty or milrinone discontinuation within 12 hours after the diagnosis of vasospasm.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>V<sub>mean</sub> was measured at vasospasm diagnosis (T<sub>DIAGNOSIS</sub>), after the induction of hypertension (T<sub>HTN</sub>), and 1 (T<sub>HTN+MILRINONE_H1</sub>) and 12 hours after the adjunction of IV milrinone (T<sub>HTN+MILRINONE_H12</sub>). Thirteen patients were included. Median V<sub>mean</sub> was significantly lower (<i>p</i> < 0.01) at T<sub>HTN+MILRINONE_H1</sub> (99 [interquartile range (IQR) 89; 134] cm.s<sup>-1</sup>) and T<sub>HTN+MILRINONE_H12</sub> (85 [IQR 73-127] cm/s) than at T<sub>DIAGNOSIS</sub> (136 [IQR 115-164] cm/s) and T<sub>HTN</sub> (148 [IQR 115-183] cm/s), whereas T<sub>DIAGNOSIS</sub> and T<sub>HTN</sub> did not significantly differ. In all patients but one, V<sub>mean</sub> at T<sub>HTN+MILRINONE_H1</sub> was lower than its value at T<sub>DIAGNOSIS</sub> (<i>p</i> = 0.0005). V<sub>mean</sub>-to-MBP and V<sub>mean</sub>-to-cardiac output (CO) ratios (an assessment of V<sub>mean</sub> regardless of the level of MBP [<i>n</i> = 13] or CO [<i>n</i> = 7], respectively) were, respectively, similar at T<sub>DIAGNOSIS</sub> and T<sub>HTN</sub> but were significantly lower after the adjunction of milrinone (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>The induction of arterial hypertension was not associated with a significant decrease in V<sub>mean</sub>, whereas the adjunction of IV milrinone was, regardless of the level of MBP or CO. This suggests that IV milrinone may succeed in relaxing spasmed arteries.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 9","pages":"e0973"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/0e/cc9-5-e0973.PMC10503695.pdf","citationCount":"0","resultStr":"{\"title\":\"Cerebral Vasospasm After Subarachnoid Hemorrhage: Respective Short-Term Effects of Induced Arterial Hypertension and its Combination With IV Milrinone: A Proof-of-Concept Study Using Transcranial Doppler Ultrasound.\",\"authors\":\"Karim Lakhal, Marion H Fresco, Antoine Hivert, Bertrand Rozec, Julien Cadiet\",\"doi\":\"10.1097/CCE.0000000000000973\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>It is unclear whether IV milrinone relaxes spasmed cerebral arteries and therefore reduces cerebral blood mean velocity (V<sub>mean</sub>). In patients treated for cerebral vasospasm, we aimed to assess and delineate the respective impacts of induced hypertension and its combination with IV milrinone on cerebral hemodynamics as assessed with transcranial Doppler.</p><p><strong>Design: </strong>Observational proof-of-concept prospective study.</p><p><strong>Setting: </strong>ICU in a French tertiary care center.</p><p><strong>Patients: </strong>Patients with aneurysmal subarachnoid hemorrhage who received induced hypertension (mean arterial blood pressure [MBP] of 100-120 mm Hg) and IV milrinone (0.5 µg/kg/min) for moderate-to-severe cerebral vasospasm. We excluded patients who underwent invasive angioplasty or milrinone discontinuation within 12 hours after the diagnosis of vasospasm.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>V<sub>mean</sub> was measured at vasospasm diagnosis (T<sub>DIAGNOSIS</sub>), after the induction of hypertension (T<sub>HTN</sub>), and 1 (T<sub>HTN+MILRINONE_H1</sub>) and 12 hours after the adjunction of IV milrinone (T<sub>HTN+MILRINONE_H12</sub>). Thirteen patients were included. Median V<sub>mean</sub> was significantly lower (<i>p</i> < 0.01) at T<sub>HTN+MILRINONE_H1</sub> (99 [interquartile range (IQR) 89; 134] cm.s<sup>-1</sup>) and T<sub>HTN+MILRINONE_H12</sub> (85 [IQR 73-127] cm/s) than at T<sub>DIAGNOSIS</sub> (136 [IQR 115-164] cm/s) and T<sub>HTN</sub> (148 [IQR 115-183] cm/s), whereas T<sub>DIAGNOSIS</sub> and T<sub>HTN</sub> did not significantly differ. In all patients but one, V<sub>mean</sub> at T<sub>HTN+MILRINONE_H1</sub> was lower than its value at T<sub>DIAGNOSIS</sub> (<i>p</i> = 0.0005). V<sub>mean</sub>-to-MBP and V<sub>mean</sub>-to-cardiac output (CO) ratios (an assessment of V<sub>mean</sub> regardless of the level of MBP [<i>n</i> = 13] or CO [<i>n</i> = 7], respectively) were, respectively, similar at T<sub>DIAGNOSIS</sub> and T<sub>HTN</sub> but were significantly lower after the adjunction of milrinone (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>The induction of arterial hypertension was not associated with a significant decrease in V<sub>mean</sub>, whereas the adjunction of IV milrinone was, regardless of the level of MBP or CO. This suggests that IV milrinone may succeed in relaxing spasmed arteries.</p>\",\"PeriodicalId\":10759,\"journal\":{\"name\":\"Critical Care Explorations\",\"volume\":\"5 9\",\"pages\":\"e0973\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-09-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/0e/cc9-5-e0973.PMC10503695.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Explorations\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/CCE.0000000000000973\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000000973","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/9/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
Cerebral Vasospasm After Subarachnoid Hemorrhage: Respective Short-Term Effects of Induced Arterial Hypertension and its Combination With IV Milrinone: A Proof-of-Concept Study Using Transcranial Doppler Ultrasound.
Objectives: It is unclear whether IV milrinone relaxes spasmed cerebral arteries and therefore reduces cerebral blood mean velocity (Vmean). In patients treated for cerebral vasospasm, we aimed to assess and delineate the respective impacts of induced hypertension and its combination with IV milrinone on cerebral hemodynamics as assessed with transcranial Doppler.
Patients: Patients with aneurysmal subarachnoid hemorrhage who received induced hypertension (mean arterial blood pressure [MBP] of 100-120 mm Hg) and IV milrinone (0.5 µg/kg/min) for moderate-to-severe cerebral vasospasm. We excluded patients who underwent invasive angioplasty or milrinone discontinuation within 12 hours after the diagnosis of vasospasm.
Interventions: None.
Measurements and main results: Vmean was measured at vasospasm diagnosis (TDIAGNOSIS), after the induction of hypertension (THTN), and 1 (THTN+MILRINONE_H1) and 12 hours after the adjunction of IV milrinone (THTN+MILRINONE_H12). Thirteen patients were included. Median Vmean was significantly lower (p < 0.01) at THTN+MILRINONE_H1 (99 [interquartile range (IQR) 89; 134] cm.s-1) and THTN+MILRINONE_H12 (85 [IQR 73-127] cm/s) than at TDIAGNOSIS (136 [IQR 115-164] cm/s) and THTN (148 [IQR 115-183] cm/s), whereas TDIAGNOSIS and THTN did not significantly differ. In all patients but one, Vmean at THTN+MILRINONE_H1 was lower than its value at TDIAGNOSIS (p = 0.0005). Vmean-to-MBP and Vmean-to-cardiac output (CO) ratios (an assessment of Vmean regardless of the level of MBP [n = 13] or CO [n = 7], respectively) were, respectively, similar at TDIAGNOSIS and THTN but were significantly lower after the adjunction of milrinone (p < 0.01).
Conclusions: The induction of arterial hypertension was not associated with a significant decrease in Vmean, whereas the adjunction of IV milrinone was, regardless of the level of MBP or CO. This suggests that IV milrinone may succeed in relaxing spasmed arteries.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
