{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:27:52Z","timestamp":1790612872430,"version":"4.1.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T00:00:00Z","timestamp":1686528000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T00:00:00Z","timestamp":1686528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Innsbruck and Medical University of Innsbruck"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurocrit Care"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Nimodipine is recommended to prevent delayed cerebral ischemia in patients with spontaneous subarachnoid hemorrhage (SAH). Here, we studied hemodynamic side effects of different nimodipine formulations (per os [PO] and intravenous [IV]) in patients with SAH undergoing continuous blood pressure monitoring.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This observational cohort study includes consecutive patients with SAH (271 included in the IV group, 49 in the PO group) admitted to a tertiary care center between 2010 and 2021. All patients received prophylactic IV or PO nimodipine. Hemodynamic responses were evaluated based on median values within the first hour after continuous IV nimodipine initiation or PO nimodipine application (601 intakes within 15\u00a0days). Significant changes were defined as\u2009&gt;\u200910% drop in systolic blood pressure (SBP) or diastolic blood pressure from baseline (median values 30\u00a0min before nimodipine application). With the use of multivariable logistic regression, risk factors associated with SBP drops were identified.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Patients were admitted with a median Hunt &amp; Hess score of 3 (2\u20135; IV 3 [2\u20135], PO 1 [1\u20132], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and were 58 (49\u201369) years of age. Initiation of IV nimodipine was associated with a\u2009&gt;\u200910% SBP drop in 30% (81\/271) of patients, with a maximum effect after 15\u00a0min. A start or increase in noradrenaline was necessary in 136\/271 (50%) patients, and colloids were administered in 25\/271 (9%) patients within 1\u00a0h after IV nimodipine initiation. SBP drops\u2009&gt;\u200910% occurred after 53\/601 (9%) PO nimodipine intakes, with a maximum effect after 30\u201345\u00a0min in 28\/49 (57%) patients. Noradrenaline application was uncommon (3% before and 4% after nimodipine PO intake). Hypotensive episodes to an SBP\u2009&lt;\u200990\u00a0mm Hg were not observed after IV or PO nimodipine application. In multivariable analysis, only a higher SBP at baseline was associated with a\u2009&gt;\u200910% drop in SBP after IV (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) or PO (<jats:italic>p<\/jats:italic>\u2009=\u20090.001) nimodipine application, after adjusting for the Hunt &amp; Hess score on admission, age, sex, mechanical ventilation, days after intensive care unit admission, and delayed cerebral ischemia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Significant drops in SBP occur in one third of patients after the start of IV nimodipine and after every tenth PO intake. Early recognition and counteracting with vasopressors or fluids seems necessary to prevent hypotensive episodes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12028-023-01760-y","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T21:01:40Z","timestamp":1686603700000},"page":"104-115","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Blood Pressure Changes in Association with Nimodipine Therapy in Patients with Spontaneous Subarachnoid Hemorrhage"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4241-5891","authenticated-orcid":false,"given":"Verena","family":"Rass","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Kindl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Lindner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Kofler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Altmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauma","family":"Putnina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan-Andrei","family":"Ianosi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alois J.","family":"Schiefecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronny","family":"Beer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Pfausler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimund","family":"Helbok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,12]]},"reference":[{"issue":"10355","key":"1760_CR1","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1016\/S0140-6736(22)00938-2","volume":"400","author":"J Claassen","year":"2022","unstructured":"Claassen J, Park S. Spontaneous subarachnoid haemorrhage. Lancet. 2022;400(10355):846\u201362.","journal-title":"Lancet"},{"key":"1760_CR2","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/MCC.0000000000000798","volume":"27","author":"V Rass","year":"2021","unstructured":"Rass V, Helbok R. How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage. Curr Opin Crit Care. 2021;27:103\u201314.","journal-title":"Curr Opin Crit Care"},{"issue":"6","key":"1760_CR3","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1161\/STR.0b013e3182587839","volume":"43","author":"ES Connolly Jr","year":"2012","unstructured":"Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association\/american Stroke Association. 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The conduct of the study was approved by the local ethics committee (Medical University of Innsbruck, AM4091-292\/4.6). Written informed consent was obtained according to local regulations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval\/Informed consent"}}]}}