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Hemodynamic Management in the Prevention and Treatment of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

  • Practice Guidance for Critical Care Management of SAH
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A Letters to the editor to this article was published on 11 July 2023

A Response to Letter To The Editor to this article was published on 11 July 2023

Abstract

One of the most serious complications after subarachnoid hemorrhage (SAH) is delayed cerebral ischemia, the cause of which is multifactorial. Delayed cerebral ischemia considerably worsens neurological outcome and increases the risk of death. The targets of hemodynamic management of SAH have widely changed over the past 30 years. Hypovolemia and hypotension were favored prior to the era of early aneurysmal surgery but were subsequently replaced by the use of hypervolemia and hypertension. More recently, the concept of goal-directed therapy targeting euvolemia, with or without hypertension, is gaining preference. Despite the evolving concepts and the vast literature, fundamental questions related to hemodynamic optimization and its effects on cerebral perfusion and patient outcomes remain unanswered. In this review, we explain the rationale underlying the approaches to hemodynamic management and provide guidance on contemporary strategies related to fluid administration and blood pressure and cardiac output manipulation in the management of SAH.

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Authors and Affiliations

  1. Neurocritical Care Unit, Swedish Medical Center, Seattle, WA, USA

    Steven Deem

  2. Department of Neurology and Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA

    Michael Diringer

  3. Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA

    Sarah Livesay

  4. College of Nursing, Rush University, Chicago, IL, USA

    Sarah Livesay

  5. Department of Anesthesiology, Duke University Medical School, Durham, NC, USA

    Miriam M. Treggiari

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Steven Deem reports no conflicts of interest or disclosures. Michael Diringer reports no conflicts of interest or disclosures. Sarah Livesay has received consulting fees from Lombardi Hill/Stroke Challenges, has received payment for expert testimony, has received support for attending meetings and/or travel from the Neurocritical Care Society, and has a leadership position in the Neurocritical Care Society. Miriam Treggiari has received grant funding from the National Institutes of Health and the Department of Defense.

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Deem, S., Diringer, M., Livesay, S. et al. Hemodynamic Management in the Prevention and Treatment of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 39, 81–90 (2023). https://doi.org/10.1007/s12028-023-01738-w

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