Vasopressin increases Cerebral Perfusion Pressure but not Cerebral Blood Flow in Neurosurgical Patients with Norepinephrine-Refractory Hypotension: A Preliminary Evaluation using the non-invasive Quantix ND in Comparison to the Literature

Abstract

Abstract The maintenance of sufficient mean arterial pressure (MAP) to sustain perfusion and oxygen delivery to all major organs is important patients in intensive care but for neurosurgical patients after SAH or TBI it is essential to avoid secondary brain damage or delayed ischemia. So far most neurosurgical intensive care units use intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as therapy guidance for those patients. Use of fluid resuscitation and norepinephrine is standard to achieve CPP between 50–70 mmHg. But sometimes norepinephrine-refractory hypotension occurs. In those cases, arginin-vasopressin (AVP) is often the drug of choice. AVP and its synthetic analogies are widely used in modern medicine and gained interest in treatment of septic shock or refractory hypotension after cardiac surgery or hypovolemic shock. Recent papers also showed a significant impact of AVP in resuscitation of after traumatic brain injury (TBI) and influence on CPP in TBI patients during ICU treatment. But little is known about the effects of AVP on cerebral perfusion and oxygenation. The present preliminary study was carried out to examine the influence of vasopressin administration on cerebral blood flow by using the non-invasive QuantixND® device. We found significantly increased MAP and CPP but no concomitant elevation in CBF. In contrast, in most patients the CBF even decreased despite elevation of CPP. We conclude that AVP is an alternative drug to maintain MAP and CPP but must be used with care in patients with already compromised cerebral perfusion.