Neurocritical Care

, 15:211

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

  • Michael N. Diringer
  • Thomas P. Bleck
  • J. Claude HemphillIII
  • David Menon
  • Lori Shutter
  • Paul Vespa
  • Nicolas Bruder
  • E. Sander ConnollyJr.
  • Giuseppe Citerio
  • Daryl Gress
  • Daniel Hänggi
  • Brian L. Hoh
  • Giuseppe Lanzino
  • Peter Le Roux
  • Alejandro Rabinstein
  • Erich Schmutzhard
  • Nino Stocchetti
  • Jose I. Suarez
  • Miriam Treggiari
  • Ming-Yuan Tseng
  • Mervyn D. I. Vergouwen
  • Stefan Wolf
  • Gregory Zipfel
Review

DOI: 10.1007/s12028-011-9605-9

Cite this article as:
Diringer, M.N., Bleck, T.P., Claude Hemphill, J. et al. Neurocrit Care (2011) 15: 211. doi:10.1007/s12028-011-9605-9

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.

Keywords

Subarachnoid hemorrhageCritical careAneurysmVasospasmAnticonvulsantsHyponatremiaEndovascularFever

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Michael N. Diringer
    • 1
  • Thomas P. Bleck
    • 2
  • J. Claude HemphillIII
    • 3
  • David Menon
    • 4
  • Lori Shutter
    • 5
  • Paul Vespa
    • 6
  • Nicolas Bruder
    • 7
  • E. Sander ConnollyJr.
    • 8
  • Giuseppe Citerio
    • 9
  • Daryl Gress
    • 10
  • Daniel Hänggi
    • 11
  • Brian L. Hoh
    • 12
  • Giuseppe Lanzino
    • 13
  • Peter Le Roux
    • 14
  • Alejandro Rabinstein
    • 13
  • Erich Schmutzhard
    • 15
  • Nino Stocchetti
    • 16
  • Jose I. Suarez
    • 17
  • Miriam Treggiari
    • 18
  • Ming-Yuan Tseng
    • 19
  • Mervyn D. I. Vergouwen
    • 20
  • Stefan Wolf
    • 21
  • Gregory Zipfel
    • 22
  1. 1.Neurology/Neurosurgery Intensive Care UnitWashington UniversitySt. LouisUSA
  2. 2.Rush Medical CollegeChicagoUSA
  3. 3.University of California at San FranciscoSan FranciscoUSA
  4. 4.University of CambridgeCambridgeUK
  5. 5.University of CincinnatiCincinnatiUSA
  6. 6.University of California at Los AngelesLos AngelesUSA
  7. 7.Université de la MéditerranéeMarseilleFrance
  8. 8.Columbia UniversityNew YorkUSA
  9. 9.San Gerardo HospitalMonzaItaly
  10. 10.University of VirginiaCharlottesvilleUSA
  11. 11.Heinrich-Heine UniversityDüsseldorfGermany
  12. 12.University of FloridaGainesvilleUSA
  13. 13.Mayo ClinicRochesterUSA
  14. 14.University of PennsylvaniaPhiladelphiaUSA
  15. 15.University Hospital InnsbruckInnsbruckAustria
  16. 16.Fondazione IRCCS Cà Granda–Ospedale Policlinico, Milan UniversityMilanItaly
  17. 17.Baylor College of MedicineHoustonUSA
  18. 18.University of WashingtonSt. LouisUSA
  19. 19.Nottingham University HospitalsNottinghamUK
  20. 20.University of UtrechtUtrechtThe Netherlands
  21. 21.Freie Universität BerlinBerlinGermany
  22. 22.Washington UniversitySt. LouisUSA