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Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers

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Abstract

Objective

To collect information on clinical practice and current management strategies in 22 Italian neurosurgical hospitals for patients with aneurysmal subarachnoid hemorrhage.

Design and setting

Observational 6-month study for prospective data collection.

Patients

350 cases of aneurysmal subarachnoid hemorrhage.

Measurements and results

Each center enrolled from 4–36 patients. Neurological deterioration (24%) was more frequent in patients with higher Fisher classification, and with pretreatment rebleeding and it was associated with an unfavorable outcome (46%, 36/78, vs. 33%, 83/251). Aneurysms were mainly secured by clipping (55%, 191/350). An endovascular approach was utilized in 35% (121/350). The more frequent medical complications were fever, recorded in one-half of cases, pneumonia (18%), sodium disturbances (hyponatremia 22%, hypernatremia 17%), cardiopulmonary events as neurogenic pulmonary edema (4%) and myocardial ischemia (5%). Intracranial hypertension was experienced in one-third of the patients, followed by hydrocephalus (29%) and vasospasm (30%). Cerebral ischemia was found in an about one-quarter of the cohort. To identify the independent predictors of outcome we developed a model in which the dichotomized Glasgow Outcome Scale was tested as function of extracranial and intracranial complications. Only high intracranial pressure and deterioration in neurological status were independent factors related to unfavorable outcome.

Conclusions

Our data confirm that in every step of care there is extreme heterogeneity among centers. These patients are complex, with comorbidities, immediate risk of rebleeding, and delayed risk of intracranial and medical complications. Following SAH early treatment and careful intensive care management requires the careful coordination of the various clinical specialties.

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Acknowledgements

The authors thank Dr. Robert D. Stevens (Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA) for his extensive editing of the manuscript and for his expert advice. The authors are indebted to the clinical research associates who participated in the data collection: Dr. R. Trigliani, M. Scerrati (Ancona Torrette); Dr.ssa P. Ceccarelli, Dr. M. Mergoni (Azienda Ospedaliera di Parma); Dr. S. Chibbaro (Cattinara Trieste); Dr. F. Tartara, Dr. P. Versari (Civile Alessandria); Dr.ssa MM. Archilli (CTO Torino); Dr. R. Potenza, Dr. CA. Castioni (G. Bosco Torino); Dr. A. Cardia (Galeazzi Milano); Dr. V. Valeriani (Galliera Genova); Dr. L. Arnaboldi (Gravedona); Dr. F. Lusenti, Dr. E. Crestan (Lecco); Dr.ssal. Cancelliere, Dott. GL. Vignazia (Maggiore Novara); Dr. F. Procaccio. Dott.ssa E. Basso (Azienda Ospedaliera di Verona); Dr. A. Caricato, Dr. E. Marchese (Policlinico A. Gemelli, Roma); Dr. L. Longhi, Dr. F. Acerbi (Policlinico Milano); Dr. R. Pugliese, Dr. R. Imberti (Policlinico San Matteo, Pavia); Dr.ssa F. Gallizzi; Dr.ssa M. Crespi (San Gerardo Monza); Dr. M. Berardino, Dr. C. Carlino (San Giovanni Battista Torino); Dr. M. Cenzato (San Raffaele Milano); Dr. D. Vidili, Dr. G. Profili (Sassari); Dr. A. Perin, Dr. M. Tripodi (Treviso); Dr. S. Peron (Varese); Dr.ssa S. Rossi (Vicenza). We gratefully acknowledge Sara Cazzaniga, PhD, for the careful review of collected the study data during and after period.

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Authors and Affiliations

  1. Neurorianimazione, Dipartimento di Medicina Perioperatoria e Terapie Intensive, Ospedale San Gerardo, Via Pergolesi 33, 20052, Monza, Italy

    Guiseppe Citerio

  2. Department of Neurological Sciences, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy

    Sergio M. Gaini

  3. Neurosurgical Clinic, University of Insubria, Ospedale Regionale, Varese, Italy

    Guistino Tomei

  4. Neuroscience ICU, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy

    Nino Stocchetti

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  1. Guiseppe Citerio
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  2. Sergio M. Gaini
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  3. Guistino Tomei
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  4. Nino Stocchetti
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Correspondence to Guiseppe Citerio.

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Citerio, G., Gaini, S.M., Tomei, G. et al. Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers. Intensive Care Med 33, 1580–1586 (2007). https://doi.org/10.1007/s00134-007-0700-5

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