title: Continuous cardiac output and near-infrared spectroscopy monitoring to assist in management of symptomatic cerebral vasospasm after subarachnoid hemorrhage.
abstract: BACKGROUND
  Hemodynamic augmentation by increasing cardiac output with dobutamine (DOB) is believed to be a useful method of elevating decreased cerebral blood flow in the territory affected by vasospasm following aneurysmal subarachnoid hemorrhage (SAH). We described the clinical utility of uncalibrated radial artery-based pulse contour cardiac output (APCO) and near-infrared spectroscopy regional cerebral oxygen saturation (rSO(2)) monitoring for reversing vasospasm symptoms with DOB-induced hyperdynamic therapy.
  
  
  METHODS
  Seven consecutive patients who underwent surgical clipping within 24 h of SAH onset and subsequently developed delayed ischemic neurological deficits attributable to vasospasm were investigated. They were treated with DOB administered at a dose of 3 μg/kg/min and then increased in 3 μg/kg/min increments until resolution of the symptoms. Continuous APCO and rSO(2) measurements in conjunction with the assessment of clinical courses and outcomes were performed.
  
  
  RESULTS
  In spasm-affected territories, decreased and/or fluctuating rSO(2) was detected at baseline compared with recordings in other brain regions. Patients who exhibited rapid elevation of APCO in response to an incremental dose of DOB had subsequent uptake and stabilization of rSO(2) followed by improvement of vasospasm-related clinical symptoms with a maximal dose of DOB, resulted in favorable functional outcomes thereafter. A fairly strong relationship was found between peak APCO slope and rSO(2) elevation, with a significantly high area under the receiver operating characteristic curve predicting neurological improvement with DOB treatment.
  
  
  CONCLUSIONS
  Our clinical experience indicates that integrative monitoring with APCO and rSO(2) may provide continuous, real-time, and clinically relevant information on the effectiveness of medical treatment of distal vessel vasospasm.
authors.affiliation: Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, 6-10 Senshu-Kubota-machi, Akita, 010-0874, Japan. tmutoh@tiara.ocn.ne.jp
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Mutoh
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Akifumi
authors.initials: A
authors.lastname: Suzuki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yasui
mesh_terms: D000368:Aged; D002302:Cardiac Output; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D017534:Radial Artery / Q000502:physiology; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
chemical_list: D010100:Oxygen