• Beate Kranawetter, Jürgen Brockmöller, Juliane Sindern, Anne Hapke, Ellen Bruns, Lars-Olav Harnisch, Onnen Moerer, Justus Stenzig, Dorothee Mielke, Veit Rohde, and Tammam Abboud.
• Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
• Crit. Care Med. 2024 Nov 21.

ObjectivesSubarachnoid hemorrhage (SAH) may critically impair cardiovascular, metabolic, and gastrointestinal function. Previous research has demonstrated compromised drug absorption in this group of patients. This study aimed to examine the impact of SAH on gastrointestinal function and its subsequent effect on the absorption of enterally administered drugs, using esomeprazole as a probe drug.DesignProspective observational cohort study.SettingAcademic hospital in Germany.PatientsWe included 17 patients with high-grade SAH and 17 controls, comparable in age, sex, body weight, and renal function, who underwent elective cranial surgery.InterventionsNone.Measurements And Main ResultsBoth groups received esomeprazole per standard protocol to prevent acid-associated mucosal damage, either orally or through a nasogastric tube. On day 4, esomeprazole was administered IV to estimate oral bioavailability. Esomeprazole serum concentrations were measured on days 1, 3, and 4 in both groups and on day 7 in the SAH group. Patients with high-grade SAH exhibited severely impaired drug absorption. Most patients showed no improvement in intestinal drug absorption even a week after hemorrhage.ConclusionsFollowing SAH, significantly reduced drug absorption may be attributed to decreased intestinal motility and compromised intestinal mucosal function. Clinicians should anticipate the reduced effectiveness of enterally administered medications for at least seven days after high-grade SAH.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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