Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations f

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.

  • Content Type Journal Article
  • Pages 1-30
  • DOI 10.1007/s12028-011-9605-9
  • Authors
    • Michael N. Diringer, Neurology/Neurosurgery Intensive Care Unit, Washington University, St. Louis, MO, USA
    • Thomas P. Bleck, Rush Medical College, Chicago, IL, USA
    • J. Claude Hemphill, University of California at San Francisco, San Francisco, CA, USA
    • David Menon, University of Cambridge, Cambridge, UK
    • Lori Shutter, University of Cincinnati, Cincinnati, OH, USA
    • Paul Vespa, University of California at Los Angeles, Los Angeles, CA, USA
    • Nicolas Bruder, Université de la Méditerranée, Marseille, France
    • E. Sander Connolly, Columbia University, New York, NY, USA
    • Giuseppe Citerio, San Gerardo Hospital, Monza, Italy
    • Daryl Gress, University of Virginia, Charlottesville, VA, USA
    • Daniel Hänggi, Heinrich-Heine University, Düsseldorf, Germany
    • Brian L. Hoh, University of Florida, Gainesville, FL, USA
    • Giuseppe Lanzino, Mayo Clinic, Rochester, MN, USA
    • Peter Le Roux, University of Pennsylvania, Philadelphia, PA, USA
    • Alejandro Rabinstein, Mayo Clinic, Rochester, MN, USA
    • Erich Schmutzhard, University Hospital Innsbruck, Innsbruck, Austria
    • Nino Stocchetti, Fondazione IRCCS Cà Granda–Ospedale Policlinico, Milan University, Milan, Italy
    • Jose I. Suarez, Baylor College of Medicine, Houston, TX, USA
    • Miriam Treggiari, University of Washington, St. Louis, MO, USA
    • Ming-Yuan Tseng, Nottingham University Hospitals, Nottingham, UK
    • Mervyn D. I. Vergouwen, University of Utrecht, Utrecht, The Netherlands
    • Stefan Wolf, Freie Universität Berlin, Berlin, Germany
    • Gregory Zipfel, Washington University, St. Louis, MO, USA


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