Review

Neurocritical Care

, 15:211

First online:

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

  • Michael N. DiringerAffiliated withNeurology/Neurosurgery Intensive Care Unit, Washington University Email author 
  • , Thomas P. BleckAffiliated withRush Medical College
  • , J. Claude HemphillIIIAffiliated withUniversity of California at San Francisco
  • , David MenonAffiliated withUniversity of Cambridge
  • , Lori ShutterAffiliated withUniversity of Cincinnati
  • , Paul VespaAffiliated withUniversity of California at Los Angeles
  • , Nicolas BruderAffiliated withUniversité de la Méditerranée
  • , E. Sander ConnollyJr.Affiliated withColumbia University
  • , Giuseppe CiterioAffiliated withSan Gerardo Hospital
    • , Daryl GressAffiliated withUniversity of Virginia
    • , Daniel HänggiAffiliated withHeinrich-Heine University
    • , Brian L. HohAffiliated withUniversity of Florida
    • , Giuseppe LanzinoAffiliated withMayo Clinic
    • , Peter Le RouxAffiliated withUniversity of Pennsylvania
    • , Alejandro RabinsteinAffiliated withMayo Clinic
    • , Erich SchmutzhardAffiliated withUniversity Hospital Innsbruck
    • , Nino StocchettiAffiliated withFondazione IRCCS Cà Granda–Ospedale Policlinico, Milan University
    • , Jose I. SuarezAffiliated withBaylor College of Medicine
    • , Miriam TreggiariAffiliated withUniversity of Washington
    • , Ming-Yuan TsengAffiliated withNottingham University Hospitals
    • , Mervyn D. I. VergouwenAffiliated withUniversity of Utrecht
    • , Stefan WolfAffiliated withFreie Universität Berlin
    • , Gregory ZipfelAffiliated withWashington University

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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 hemorrhage Critical care Aneurysm Vasospasm Anticonvulsants Hyponatremia Endovascular Fever