Perioperative Control Of Acute High Blood Pressure In Neurosurgical Patients Admitted To Intensive Care Unit Using Clevidipine (Neuro-Clev)

Background: Effective treatment of acute high blood pressure in neurocritical diseases is a current recommendation of guidelines to reduce mortality and severe disability. Clevidipine is a calcium channel blocker that showed effectiveness and safety for acute high blood pressure control in neurocritical patients. Materials and methods: Retrospective, observational and cross-sectional study in adult patients admitted to Intensive Care Unit for neurocritical disease requiring surgical or interventional treatment and presenting acute high blood pressure requiring urgent treatment with clevidipine as first line or rescue therapy after failure of different intravenous antihypertensive drugs. Primary endpoint was effectiveness of clevidipine treatment. Secondary endpoint was safety of clevidipine treatment. Analysis of subgroups described patient and treatment variables on effectiveness and safety of clevidipine, mortality, functional situation and major neurologic complications. Hematoma expansion, rebleeding and vasospasm were specific neurological complications described. Comparisons was made using Fisher, chi-square, t or Mann Whitney U test. Significance was set at the 5% level. Analysis was made using IBM SPSS Statistics 23.0 Results: thirty-three patients admitted to Intensive Care Unit fulfilled inclusion criteria and were included. Clevidipine showed a higher effectiveness and safety for acute high blood pressure control in our patients. Effectiveness was higher in patients with larger brain hematomas and severe aneurysmal subarachnoid hemorrhages treated with first line and early began of clevidipine within 24 hours of admission. Adverse events were mild, transient and more frequent in patients with first line treatment. Early and effective treatment were safe with lower major neurological complications. Mortality was lower in patients with first line and effective treatment. Hematoma expansion was seen in a higher number of patients. Rebleeding and vasospasm were less frequent. Conclusion: Clevidipine was effective and safe treatment of acute high blood pressure in neurocritical patients. Severity of neurocritical disease is a key factor but early and effective treatment could contribute to reduce mortality and major neurological complications. Nevertheless, our results need to take with caution because little size and design of our study. Trial registration: NCT05168059