Perioperative Fever and Outcome in Surgical Patients With Aneurysmal Subarachnoid Hemorrhage

Todd, Michael M.; Hindman, Bradley J.; Clarke, William R.; Torner, James C.; Weeks, Julie B.; Bayman, Emine O.; Shi, Qian; Spofford, Christina M.

doi:10.1227/01.neu.0000341903.11527.2f

Cited by 67 publications

(35 citation statements)

References 27 publications

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“…The study showed that hypothermia was relatively safe but was not associated with a beneficial effect in mortality or neurological outcome among patients with good-grade aSAH. 189 In addition, intraoperative hypothermia had no beneficial effect on neuropsychological function after SAH. 190 Of note, the power of these 2 studies was not sufficient to detect more modest benefits from hypothermia, and there were some trends in favor of hypothermia for secondary end points.…”

Section: Anesthetic Management During Surgical and Endovascular Treatmentioning

confidence: 97%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,889

1,375

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Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

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Section: Anesthetic Management During Surgical and Endovascular Treatmentioning

confidence: 97%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,889

1,375

View full text Add to dashboard Cite

show abstract

“…However, one can only definitively say that fever is associated with worsened outcomes, it may not be causative. In other words, it may simply be a marker of bad outcomes (45).…”

Section: Therapeutic Hypothermia For Subarachnoid Hemorrhagementioning

confidence: 99%

Hypothermia for Intracerebral Hemorrhage, Subarachnoid Hemorrhage & Spinal Cord Injury

Tannehill¹

2013

Therapeutic Hypothermia in Brain Injury

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“…Often, an infectious source is not found. Greater burden of fever is related to worse outcomes after IPH (51) and SAH (52,53).…”

Section: Treatment and Medical Complications Of Intracranial Hemorrhamentioning

confidence: 99%

Intracranial Hemorrhage

Naidech

2011

Am J Respir Crit Care Med

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Intracranial hemorrhage is a life-threatening condition, the outcome of which can be improved by intensive care. Intracranial hemorrhage may be spontaneous, precipitated by an underlying vascular malformation, induced by trauma, or related to therapeutic anticoagulation. The goals of critical care are to assess the proximate cause, minimize the risks of hemorrhage expansion through blood pressure control and correction of coagulopathy, and obliterate vascular lesions with a high risk of acute rebleeding. Simple bedside scales and interpretation of computed tomography scans assess the severity of neurological injury. Myocardial stunning and pulmonary edema related to neurological injury should be anticipated, and can usually be managed. Fever (often not from infection) is common and can be effectively treated, although therapeutic cooling has not been shown to improve outcomes after intracranial hemorrhage. Most functional and cognitive recovery takes place weeks to months after discharge; expected levels of functional independence (no disability, disability but independence with a device, dependence) may guide conversations with patient representatives. Goals of care impact mortality, with do-not-resuscitate status increasing the predicted mortality for any level of severity of intraparenchymal hemorrhage. Future directions include refining the use of bedside neuromonitoring (electroencephalogram, invasive monitors), novel approaches to reduce intracranial hemorrhage expansion, minimizing vasospasm, and refining the assessment of quality of life to guide rehabilitation and therapy.

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Perioperative Fever and Outcome in Surgical Patients With Aneurysmal Subarachnoid Hemorrhage

Cited by 67 publications

References 27 publications

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Hypothermia for Intracerebral Hemorrhage, Subarachnoid Hemorrhage & Spinal Cord Injury

Intracranial Hemorrhage

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