NCS is a multidisciplinary, international organization whose mission is to improve outcomes for patients with critical neurological illnesses.

Chicago, IL
Joined March 2011
Neurocritical Care Society retweeted
I voted for functional but your thought process makes me hold DCI in higher regard for outcomes. Important we don't just think of patients as numbers (ie mRS) and take into consideration what they hold as a 'good' outcome. #NCSTJC
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Neurocritical Care Society retweeted
I voted DCI incidence as I believe is the most meaningful outcome tied to vasospasm prevention and treatment. Functional outcome is the ultimate goal but will be affected by multiple factors not necessarily related to vasospasm. #NCSTJC
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Neurocritical Care Society retweeted
We start at 0.5 mcg/kg/min and titrate by 0.25 up to a max of 2. We typically do not start with an initial bolus. Most of these patients are usually already on pressors, but either norepi or phenyl is our go to #NCSTJC
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Neurocritical Care Society retweeted
Our upper limit is SBP of 220 haha We rarely go that high but I haven't seen rebleeds when we've really cranked it up #NCSTJC
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Neurocritical Care Society retweeted
SBP goals make sense for rebleed/bleed expansion as that's better correlated with shear force against a vessel wall, but for vasospasm treatment it probably doesn't make a big difference I want to see who's out there using DBP targets... there's gotta be someone #NCSTJC
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Agreed with the polyuria, this has been a big educational point with milrinone and the importance of adjusting fluids to maintain euvolemia for these patients, especially since these patients are in the vasospasm window
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Increased UOP is definitely something I see in the patients we start on milrinone The other thing I found wild about this study was their threshold for the upper limit of norepi was 1.5mcg/kg/min... That is like vasoplegic shock dosing 😳
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Neurocritical Care Society retweeted
This is my major criticism of this study as well - would have been interesting to look at their aSAH outcomes over time irrespective of milrinone. They may have just gotten better at aSAH, had more sensitive imaging to detect spasm, etc #NCSTJC
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Neurocritical Care Society retweeted
I voted functional outcomes, but with the complexity of aSAH care its hard to isolate the effect size of 1️⃣ intervention VS resolution is great but is still a surrogate outcome. Whether it's the spasm or something like CSD driving outcomes has yet to be seen #NCSTJC
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Q5: What is the most meaningful outcome to assess in vasospasm treatment studies for SAH? #NCSTJC @theABofPharmaC @karenccrx
1% Angiographic ↓ vasospasm
30% Incidence of DCI
68% Functional outcome
0% Other (reply)
82 votes • Final results
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Neurocritical Care Society retweeted
Especially in absence concurrent heart failure, high output state induced by milrinone presumably causes kidney hyperperfusion, diuresis and natriuresis, with K loss.
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I think MAP goals are in general more physiologically reasonable, extrapolating from general intensive care, but unfortunately still many recent studies on SAH aim for SBP, which might be a problem. Especially in cronic hypertonics with large discrepancy between sBP and dBP.
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Neurocritical Care Society retweeted
Why SBP or why MAP? #NCSTJC
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Neurocritical Care Society retweeted
#NCSTJC Some other studies have proposed much higher dose intervals for Milrinone, as for example 2-3 mcg/kg/min. Quite high dose when compared to general indications for Milninone like right vetricular failure? Does anyone has comments on that?
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Neurocritical Care Society retweeted
Not in our formulary yet but discussions ongoing
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Neurocritical Care Society retweeted
Been using for awhile. Start 0.5 , usually keep there. Levo/vaso if needed
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Not too often that we use this but if we do, we've already trialed induced HTN. Starting dose is usually an infusion at 0.75 mcg/kg/min and if no improvement after an hour increase by 0.25 mcg/kg/min every hour up to a max of 1.25 mcg/kg/min.
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Neurocritical Care Society retweeted
CVP > 6. An old hemodynamic test. Do you perform other? #NCSTJC
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Neurocritical Care Society retweeted
We dont use for VE. By now is off label. May be this discussion help to use. #NCSTJC
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Neurocritical Care Society retweeted
It's a great option for those who can tolerate it without experiencing the potential adverse effects. Hypotension and arrhythmias can limit its utility-- especially in a setting where you may be simultaneously augmenting/maintaining BP with pressors. #NCSTJC
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