Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference

Abstract

Subarachnoid hemorrhage (SAH) is an acute cerebrovascular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs. SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team. A lack of high quality data has led to numerous approaches to management and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of rebleeding, but provide limited discussion of the complex critical care issues involved in the care of SAH patients. The Neurocritical Care Society organized an international, multidisciplinary consensus conference on the critical care management of SAH to address this need. Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise. A jury of four experienced neurointensivists was selected for their experience in clinical investigations and development of practice guidelines. Recommendations were developed based on literature review using the GRADE system, discussion integrating the literature with the collective experience of the participants and critical review by an impartial jury. Recommendations were developed using the GRADE system. Emphasis was placed on the principle that recommendations should be based not only on the quality of the data but also tradeoffs and translation into practice. Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data.

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

“…Subjects' written informed consent was obtained according to the Declaration of Helsinki. The clinical care of SAH patients conformed to guidelines set forth by the Neurocritical Care Society, the American Heart Association/American Stroke Association and the European Stroke Organization 9, 10, 11. All patients were followed with every‐other‐day transcranial Doppler sonography (DWL Doppler‐Box system; Compumedics, Singen Germany) and received oral or intravenous nimodipine.…”

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

“…[9][10][11][12][13][14] Many of the treatments that are recommended in consensus guidelines and incorporated into protocols are, by necessity, based on low-quality evidence derived largely from observational studies. [15][16][17][18][19] For example, over the past decade it has become common practice to prevent/treat aggressively even relatively mild derangements in core body temperature, blood glucose levels, and serum sodium and hemoglobin concentrations. [20][21][22][23] With increasing use of electroencephalography, it has been recognized that many neurocritical care patients develop non-convulsive seizures, which most experts believe should be prevented or expeditiously diagnosed and treated.…”

Decompressive craniotomy in patients with intracranial aneurysmal hemorrhage

“…Помимо операций по выключению аневризм, многим больным устанавливали наружный вентрику-лярный дренаж непосредственно при поступлении или после основной операции. Послеоперационное ведение и медикаментозное лечение в подавляющем большин-стве исследований осуществлялись в соответствии с международными рекомендательными протоколами [24][25][26]. Во многих исследованиях осуществляли до-операционный и/или послеоперационный контроль ВЧД с помощью паренхиматозных или вентрикулярных датчиков, что также входит в стандарт лечения тяжелых больных [26].…”

“…Малое количество и низкая достоверность имеющих-ся в литературе данных по ДТЧ не дают оснований для того, чтобы эта операция была включена в число меро-приятий, рекомендуемых международными протоколами по лечению больных с аневризматическим внутричереп-ным кровоизлиянием [24][25][26].…”