Enteral Nimodipine in Aneurysmal Subarachnoid Hemorrhage (Real World Application and Challenges)
Bibliographic record
Abstract
Abstract Background/Objective: Aneurysmal subarachnoid hemorrhage (aSAH) has an estimated mortality rate of 32% and complications include cerebral vasospasm, delayed cerebral ischemia and hydrocephalus. Guidelines recommend nimodipine as standard of care. Nimodipine has been shown to reduce death and dependency on others for activities of daily living and secondary ischemia, when compared to placebo. Our primary objective was to determine the proportion of patients with aSAH admitted to intensive care unit (ICU) or high acuity unit (HAU) at a tertiary referral hospital who received guideline recommended dose and duration of nimodipine. Our secondary objectives were to characterize usage and prescribing practices of nimodipine and describe barriers to receiving full treatment. Methods We conducted a retrospective chart review of 100 patients diagnosed with aSAH admitted to the intensive care unit (ICU) or high acuity unit (HAU) at a tertiary referral hospital between January 1st, 2012 and August 31st, 2022. Descriptive statistics were used during statistical analysis. Results One patient with aSAH admitted to critical care received the guideline recommended dose and duration of nimodipine. Ninety five percent of patients experienced a delay to initiation. Reasons included transfer from another hospital site (47%) and lack of safe enteral route (65%). Sixty-six percent of patients received alternative dosing. Reasons included blood pressure below target (24%) and vasospasm requiring a higher blood pressure target (33%). A total of 13% experienced treatment interruption and 86% had nimodipine discontinued early. Reasons included vasospasm requiring a higher blood pressure target (12%) and nimodipine not being continued on transfer/discharge (14%). Fourty-four percent of our patients experienced mortality. Conclusion Patients fail to receive full course of nimodipine treatment due to multiple barriers during the treatment course. Pharmacists can play a role in optimizing nimodipine treatment through educating transferring sites on timely initiation, reconciling medications on transfer and discharge and mitigating interactions with concomitant medications.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".