J Neurointensive Care.  2021 Apr;4(1):1-5. 10.32587/jnic.2020.00318.

An Observational Study on the Effect of Nimodipine on Cerebral Blood Flow Velocity and Oxygenation in Patients with Subarachnoid Haemorrhage

• Chackupurakal R
• Gebauer M
• Dusse F
• Hartmann A
• Nakamura M
• Wappler F
• Sakka SG

• KMID: 2555043
• DOI: http://doi.org/10.32587/jnic.2020.00318

Abstract

Objective
In patients with subarachnoid haemorrhage (SAH), nimodipine is administered to prevent for cerebral vasospasm. In this prospective observational study, we examined the effect of nimodipine on cerebral blood flow velocity (BFV) (transcranial Doppler, TCD) and regional oxygen saturation (rSO2) (near-infrared spectroscopy, NIRS) as well as its systemic haemodynamic effects.
Methods
After ethics approval, we enrolled 18 adult patients (11 females) with SAH after aneurysm rupture. After treatment of the bleeding source, patients underwent extended haemodynamic monitoring by transpulmonary thermodilution (PiCCOTM, Pulsion, Maquet Getinge Group, Feldkirchen, Germany). Measurements of systemic haemodynamics as well as cerebral oxygenation and blood flow velocity were performed 30 minutes before and after the enteral administration of nimodipine (60 mg). Data was compared by paired t-test. A p<0.05 was considered as statistically significant. Data are expressed as mean ± SD.
Results
Patients’ mean age was 59 ± 11 years. Enteral nimodipine administration was associated with a decrease in mean arterial pressure (93 vs. 88 mmHg, p<0.05), an increase in heart rate (75 vs. 79/min, p<0.05) and cardiac index (3.27 vs. 3.58 l/min/m2, p<0.05). While noradrenaline dose and BFV did not change significantly, NIRS revealed a reduction in cerebral oxygenation, but rSO2 values remained within a healthy range in all patients (right 71 vs. 69 %, p<0.05; left 74 vs. 72 %, p<0.05).
Conclusions
In patients with SAH, enteral nimodipine led to inconclusive changes in systemic haemodynamics. Although cerebral oxygenation as assessed by NIRS decreased after nimodipine administration, BFV remained stable.

Keyword

Cerebral blood flow velocity; Cerebral oxygenation; Nimodipine; Subarachnoid haemorrhage; Systemic haemodynamics