title: Dobutamine-induced high cardiac index did not prevent vasospasm in subarachnoid hemorrhage patients: a randomized controlled pilot study.
abstract: BACKGROUND
  Prevention of vasospasm is a challenging issue in subarachnoid hemorrhage (SAH) patients and the objective is to compare high dobutamine-induced cardiac index (CI) and high norepinephrine-induced hypertension for the prevention of vasospasm in SAH patients.
  
  
  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 ≥100 mmHg. Norepinephrine could be used in the dobutamine group to maintain a cerebral pressure perfusion ≥60 mmHg. Primary endpoint was the incidence of angiographic vasospasm in the first 14 days 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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  As compared to norepinephrine-induced hypertension, dobutamine-induced high CI did not reduce the rate of vasospasm in SAH patients. Dobutamine may reduce durations of mechanical ventilation and ICU LOS.
authors: Service Anesthésie-Réanimation, Hôpital Guillaume et René Laennec, Boulevard Jacques Monod, Centre Hospitalo-Universitaire, 44093 cedex Nantes, France. nelly.rondeau@chu-nantes.fr
authors: Nelly
authors: N
authors: Rondeau
authors: Raphaël
authors: R
authors: Cinotti
authors: Bertrand
authors: B
authors: Rozec
authors: Antoine
authors: A
authors: Roquilly
authors: Hervé
authors: H
authors: Floch
authors: Nicolas
authors: N
authors: Groleau
authors: Patrick
authors: P
authors: Michel
authors: Karim
authors: K
authors: Asehnoune
authors: Yvonnick
authors: Y
authors: Blanloeil
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D001921:Brain / Q000098:blood supply; D004280:Dobutamine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D010865:Pilot Projects; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016037:Single-Blind Method; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D013566:Sympathomimetics / Q000627:therapeutic use*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000150:complications / Q000517:prevention & control*
chemical_list: D013566:Sympathomimetics; D004280:Dobutamine; D009638:Norepinephrine