Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial

Dong，Rui1; Li，Fen1; Li，Bin2; Chen，Qiming2; Huang，Xianjian3; Zhang，Jiehua3; Huang，Qibing4; Zhang，Zeli4; Cao，Yunxing2; Yang，Mingbiao5; Li，Jianwei1; Li，Zhanfu6; Li，Cuiyu7; Liu，Guohua8; Zhong，Shu9; Feng，Guang10; Zhang，Ming10; Xiao，Yumei11; Lin，Kangyue8; Shen，Yunlong12; Shao，Huanzhang10; Shi，Yuan11; Yu，Xiangyou12; Li，Xiaopeng12; Yao，Lan13; Du，Xinyu13; Xu，Ying14; Kang，Pei14; Gao，Guoyi15; Ouyang，Bin16; Chen，Wenjin17; Zeng，Zhenhua18; Chen，Pingyan19; Chen，Chunbo20; Yang，Hong1

2024-07-01

10.1097/ALN.0000000000004986

Anesthesiology   影响因子和分区

0003-3022

1528-1175

Background: Although it has been established that elevated blood pressure and its variability worsen outcomes in spontaneous intracerebral hemorrhage, antihypertensives use during the acute phase still lacks robust evidence. A blood pressure-lowering regimen using remifentanil and dexmedetomidine might be a reasonable therapeutic option given their analgesic and antisympathetic effects. The objective of this superiority trial was to validate the efficacy and safety of this blood pressure-lowering strategy that uses remifentanil and dexmedetomidine in patients with acute intracerebral hemorrhage. Methods: In this multicenter, prospective, single-blinded, superiority randomized controlled trial, patients with intracerebral hemorrhage and systolic blood pressure (SBP) 150 mmHg or greater were randomly allocated to the intervention group (a preset protocol with a standard guideline management using remifentanil and dexmedetomidine) or the control group (standard guideline-based management) to receive blood pressure-lowering treatment. The primary outcome was the SBP control rate (less than 140 mmHg) at 1 h posttreatment initiation. Secondary outcomes included blood pressure variability, neurologic function, and clinical outcomes. Results: A total of 338 patients were allocated to the intervention (n = 167) or control group (n = 171). The SBP control rate at 1 h posttreatment initiation in the intervention group was higher than that in controls (101 of 161, 62.7% vs. 66 of 166, 39.8%; difference, 23.2%; 95% CI, 12.4 to 34.1%; P < 0.001). Analysis of secondary outcomes indicated that patients in the intervention group could effectively reduce agitation while achieving lighter sedation, but no improvement in clinical outcomes was observed. Regarding safety, the incidence of bradycardia and respiratory depression was higher in the intervention group. Conclusions: Among intracerebral hemorrhage patients with a SBP 150 mmHg or greater, a preset protocol using a remifentanil and dexmedetomidine-based standard guideline management significantly increased the SBP control rate at 1 h posttreatment compared with the standard guideline-based management.

SCI

英语

其他

CLINICAL MEDICINE

2-s2.0-85195708930

Scopus

1.Department of Critical Care Medicine,The Third Affiliated Hospital,Southern Medical University,Guangzhou,China
2.Department of Intensive Care Unit,The First Hospital of Lanzhou University,Lanzhou,China
3.Department of Neurosurgery,Shenzhen Key Laboratory of Neurosurgery,The First Affiliated Hospital of Shenzhen University,Shenzhen Second People's Hospital,Shenzhen,China
4.Department of Emergency Neurosurgical Intensive Care Unit,Qilu Hospital of Shandong University,Brain Science Research Institute of Shandong University,Jinan,China
5.Neurosurgery Department,The First Affiliated Hospital,Hunan University of Medicine,Huaihua,China
6.
7.Department of Intensive Care Unit,Guangdong Sanjiu Brain Hospital,Guangzhou,China
8.Department of Neurosurgery,The Fifth Affiliated Hospital,Southern Medical University,Guangzhou,China
9.Department of Neurosurgery,Guangxi Hospital Division,First Affiliated Hospital,Sun Yat-sen University,Nanning,China
10.Department of Neurosurgery,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou,China
11.Neurological Intensive Medicine Department,Maoming People's Hospital,Maoming,China
12.Department of Critical Care Medicine,The First Affiliated Hospital,Xinjiang Medical University,Urumqi,China
13.Department of Emergency Medicine,The Fifth Affiliated Hospital,Sun Yat-sen University,Zhuhai,China
14.
15.Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing,China
16.Department of Critical Care Medicine,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China
17.Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing,China
18.Department of Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou,China
19.Department of Biostatistics,School of Public Health,Southern Medical University,Guangzhou,China
20.Department of Critical Care Medicine,Shenzhen People's Hospital,The Second Clinical Medical College,Jinan University,The First Affiliated Hospital,Southern University of Science and Technology,Shenzhen,China

Dong，Rui,Li，Fen,Li，Bin,et al. Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial[J]. Anesthesiology,2024,141(1):100-115.

Dong，Rui.,Li，Fen.,Li，Bin.,Chen，Qiming.,Huang，Xianjian.,...&Yang，Hong.(2024).Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial.Anesthesiology,141(1),100-115.

Dong，Rui,et al."Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial".Anesthesiology 141.1(2024):100-115.