Key result
Hypertensive therapy with norepinephrine increases cerebral blood flow velocity only when autoregulation is impaired in patients with aneurysmal subarachnoid hemorrhage.
Why the study?
Vasopressors are used in subarachnoid hemorrhage to increase blood pressure and reverse ischemia, but the systemic and cerebral hemodynamic changes at different pharmacologically augmented blood pressure levels required evaluation.
Does pharmacologically induced blood pressure manipulation with norepinephrine improve cerebral blood flow velocity in patients with aneurysmal subarachnoid hemorrhage?
Observational
Does pharmacologically induced blood pressure manipulation with norepinephrine improve cerebral blood flow velocity in patients with aneurysmal subarachnoid hemorrhage?
p-value: p=0.113
In patients with aneurysmal subarachnoid hemorrhage, norepinephrine-induced hypertension increases cerebral blood flow velocity specifically when autoregulation is impaired.
May support targeted norepinephrine use in SAH with impaired autoregulation; leaves open effects on clinical outcomes.
Background: Vasopressors are used in patients with subarachnoid hemorrhage (SAH) to increase blood pressure with the idea of reversing the ischemic process. The current study is designed to evaluate the changes in systemic and cerebral hemodynamics, including cerebral blood flow autoregulation, at different pharmacologically augmented blood pressure levels using norepinephrine in patients with spontaneous aneurysmal SAH following surgery. Materials and methods: This prospective observational study was carried out in patients with ruptured anterior circulation aneurysms who underwent surgical clipping and required norepinephrine infusion. Postoperatively, when the treating physician decided to start a vasopressor, norepinephrine infusion was started at 0.05 µg/kg/min. The infusion rate was increased by 0.05 µg/kg/min every 5 minutes to achieve a 20% and then 40% increase in the systolic blood pressure (SBP). When the blood pressure stabilized at each level for 5 minutes, hemodynamic and transcranial doppler (TCD) parameters in the middle cerebral artery (MCA) were recorded. Results: 0.113). Conclusion: Hypertensive therapy with norepinephrine increases cerebral blood flow velocity only when autoregulation is impaired, an effect that is desirable in patients with focal cerebral ischemia following SAH. How to cite this article: Lakshmegowda M, Muthuchellapan R, Sharma M, Ganne SUR, Chakrabarti D, Muthukalai S. The Effect of Pharmacologically Induced Blood Pressure Manipulation on Cardiac Output and Cerebral Blood Flow Velocity in Patients with Aneurysmal Subarachnoid Hemorrhage. Indian J Crit Care Med 2023;27(4):254-259.
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Sharma et al. (2023) conducted an observational in Aneurysmal subarachnoid hemorrhage (SAH). Pharmacologically induced blood pressure manipulation using norepinephrine was evaluated on Changes in systemic and cerebral hemodynamics, including cerebral blood flow autoregulation (p=0.113). Hypertensive therapy with norepinephrine increases cerebral blood flow velocity only when autoregulation is impaired in patients with aneurysmal subarachnoid hemorrhage.
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