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Dobutamine-Induced High Cardiac Index did not Prevent Vasospasm in Subarachnoid Hemorrhage Patients: A Randomized Controlled Pilot Study
Neurocritical Care , 07/31/2012
Clinical Article
Rondeau N et al. – As compared to norepinephrine–induced hypertension, dobutamine–induced high cardiac index (CI) did not reduce the rate of vasospasm in subarachnoid hemorrhage (SAH) patients. Dobutamine may reduce durations of mechanical ventilation and intensive care unit (ICU) length of stay (LOS).
Methods- Single center, single blind, controlled randomized study.
- Patients hospitalized in intensive care unit (ICU) for a moderate to severe SAH (WFNS grade≥2) were randomized to receive dobutamine to reach a 25 % increase in cardiac index or norepinephrine to reach a mean arterial pressure ≥100mmHg.
- Norepinephrine could be used in the dobutamine group to maintain a cerebral pressure perfusion ≥60mmHg.
- Primary endpoint was the incidence of angiographic vasospasm in the first 14days in the ICU setting, which was upheld by a cerebral arteriography.
- Secondary endpoints were the incidence of delayed ischemic deficits, duration of mechanical ventilation, and ICU length of stay (LOS).
- During the 3–year study, 41 patients were randomized.
- Six patients were excluded–3 because of consent withdrawal and 3 who did not receive the assigned treatment.
- Respectively, 17 and 18 patients in the dobutamine and the norepinephrine group were kept in analysis.
- Five (28 %) patients in the dobutamine group and 5 (27 %) patients in the norepinephrine group developed vasospasm in ICU (p=1).
- Seven (41 %) patients presented a delayed ischemic deficit in the dobutamine group and 9 (50 %) in the norepinephrine group (p=0.24).
- Duration of mechanical ventilation was 8 [0.5–11.5]days in the dobutamine group and 19 [2.7–23]days in the norepinephrine group (p=0.01).
- ICU LOS was 11 [6–15]days in the dobutamine group and 21 [9–28]days in the norepinephrine group (p=0.01).