PMID- 37720356
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230920
IS  - 2639-8028 (Electronic)
IS  - 2639-8028 (Linking)
VI  - 5
IP  - 9
DP  - 2023 Sep
TI  - 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.
PG  - e0973
LID - 10.1097/CCE.0000000000000973 [doi]
LID - e0973
AB  - OBJECTIVES: It is unclear whether IV milrinone relaxes spasmed cerebral arteries 
      and therefore reduces cerebral blood mean velocity (V(mean)). 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. DESIGN: Observational 
      proof-of-concept prospective study. SETTING: ICU in a French tertiary care 
      center. 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 microg/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: V(mean) was measured at vasospasm diagnosis (T(DIAGNOSIS)), after 
      the induction of hypertension (T(HTN)), and 1 (T(HTN+MILRINONE_H1)) and 12 hours 
      after the adjunction of IV milrinone (T(HTN+MILRINONE_H12)). Thirteen patients 
      were included. Median V(mean) was significantly lower (p < 0.01) at 
      T(HTN+MILRINONE_H1) (99 [interquartile range (IQR) 89; 134] cm.s(-1)) and 
      T(HTN+MILRINONE_H12) (85 [IQR 73-127] cm/s) than at T(DIAGNOSIS) (136 [IQR 
      115-164] cm/s) and T(HTN) (148 [IQR 115-183] cm/s), whereas T(DIAGNOSIS) and 
      T(HTN) did not significantly differ. In all patients but one, V(mean) at 
      T(HTN+MILRINONE_H1) was lower than its value at T(DIAGNOSIS) (p = 0.0005). 
      V(mean)-to-MBP and V(mean)-to-cardiac output (CO) ratios (an assessment of 
      V(mean) regardless of the level of MBP [n = 13] or CO [n = 7], respectively) 
      were, respectively, similar at T(DIAGNOSIS) and T(HTN) 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 V(mean), 
      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.
CI  - Copyright (c) 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf 
      of the Society of Critical Care Medicine.
FAU - Lakhal, Karim
AU  - Lakhal K
AD  - Department of Anesthesia and Critical Care, Laennec Hospital, University Hospital 
      of Nantes, France.
FAU - Fresco, Marion H
AU  - Fresco MH
AD  - Department of Anesthesia and Critical Care, Laennec Hospital, University Hospital 
      of Nantes, France.
FAU - Hivert, Antoine
AU  - Hivert A
AD  - Department of Anesthesia and Critical Care, Laennec Hospital, University Hospital 
      of Nantes, France.
FAU - Rozec, Bertrand
AU  - Rozec B
AD  - Department of Anesthesia and Critical Care, Laennec Hospital, University Hospital 
      of Nantes, France.
AD  - Institut du Thorax, Institut National de la Sante et de la Recherche Medicale 
      (INSERM), Centre National de la Recherche Scientifique (CNRS), Universite de 
      Nantes, Nantes, France.
FAU - Cadiet, Julien
AU  - Cadiet J
AD  - Department of Anesthesia and Critical Care, Laennec Hospital, University Hospital 
      of Nantes, France.
LA  - eng
PT  - Journal Article
DEP - 20230914
PL  - United States
TA  - Crit Care Explor
JT  - Critical care explorations
JID - 101746347
PMC - PMC10503695
OTO - NOTNLM
OT  - Doppler
OT  - cerebrovascular circulation/drug effects
OT  - delayed ischemia
OT  - intracranial
OT  - milrinone
OT  - subarachnoid hemorrhage
OT  - transcranial
OT  - ultrasonography
OT  - vasospasm
COIS- Dr. Lakhal received, during the past 3 years, congress registration from Pfizer 
      (once in 2022) and both congress registration and travel fees from Pfizer (once 
      in 2020) and Advanz Pharma/Correvio (twice, in 2020 and once in 2021). Dr. Rozec 
      received, during the past 5 years, lecture fees from Fisher and Paykel, Baxter, 
      Laboratoire du Fractionnement et des Biotechnologies, and Aspen, research grants 
      from Baxter and Aguettant, and consulting fees from Laboratoire du Fractionnement 
      et des Biotechnologies, Aguettant, and Astra Zeneca. The remaining authors have 
      not disclosed any potential conflicts of interest.
EDAT- 2023/09/18 06:42
MHDA- 2023/09/18 06:43
PMCR- 2023/09/14
CRDT- 2023/09/18 04:39
PHST- 2023/09/18 06:43 [medline]
PHST- 2023/09/18 06:42 [pubmed]
PHST- 2023/09/18 04:39 [entrez]
PHST- 2023/09/14 00:00 [pmc-release]
AID - 10.1097/CCE.0000000000000973 [doi]
PST - epublish
SO  - Crit Care Explor. 2023 Sep 14;5(9):e0973. doi: 10.1097/CCE.0000000000000973. 
      eCollection 2023 Sep.