Perioperative Control of Acute High Blood Pressure in Neurosurgical Patients Admitted to Intensive Care Unit Using Clevidipine (NEURO-CLEV)
Background: Effective treatment of hypertension in neurocritical diseases is a current recommendation of guidelines. Clevidipine had showed effectiveness and safety for hypertension control in neurocritical patients.
Methods: Retrospective, observational and cross-sectional study in adult patients admitted to Intensive Care Unit for neurocritical disease requiring surgical or interventional treatment and presenting hypertension requiring urgent treatment with clevidipine as first line or rescue therapy after failure of different intravenous antihypertensive drugs. This study aimed to observe effectiveness and safety of clevidipine treatment in these patients. We conducted a subgroup analysis to observe possible confounder factors on effectiveness and safety of clevidipine treatment, major neurological complications and mortality.
Results: Thirty-three patients fulfilled inclusion criteria. Clevidipine was effective and safety for urgent control of hypertension in our patients. Effectiveness was higher in patients with larger brain hematomas and more severe subarachnoid hemorrhages treated with clevidipine as first line beginning within first 24 hours of admission. Subgroup of patients under effective treatment with clevidipine showed a slightly lower incidence of major neurological complications and mortality than global group. Early treatment within 24 hours of admission subgroup showed a lower incidence of major neurological complications than global group. No mortality was observed when clevidipine was first line treatment.
Conclusion: Clevidipine was effective and safe treatment of hypertension in our neurocritical patients. Severity of neurocritical disease is a key factor but effective treatment with clevidipine could contribute to reduce mortality and major neurological complications. Early treatment could prevent major neurological complications. First line treatment with clevidipine could reduce mortality. Nevertheless, our results based in a little size and retrospective study warranting further investigation in larger trials.