Current intensive care management proposals after aneurysmal subarachnoid hemorrhage
Aneurysmal subarachnoid (SAH) is a serious disease associated with considerable mortality and morbidity: it accounts for 6-10% of all strokes and 22-25% of cerebrovascular deaths (46). The most common causes of death or disability include direct effect of initial bleed and rebleeding (5). Subsequent causes of death include vasospasm (43), hydrocephalus, and surgical and medical complications of SAH treatment. After surgery patients remain at risk of developing secondary neurologic deficits and medical complications for at least 2 to 3 weeks. During this period patients are closely monitored for early detection of onset of delayed ischemic symptoms. As no good evidence exists to support hypertensive and hemodilution therapy to prevent vasospasm, the initial goal should be oriented to maintain euvolemia, considering that patients potentially have pronounced negative fluid balance and then considerable maintenance fluids and sodium must be substituted. However, if symptoms of delayed cerebral ischemia appear, the goals of treatment are immediately converted to hypertensive hypervolemic and hemodilution therapy. Oral, when possible, otherwise intravenous Nimodipine is recommended, its dosage must be adapted to maintain the desired blood pressure.
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Published In
DOI
ISSN
Publication Date
Volume
Issue
Start / End Page
Related Subject Headings
- Emergency & Critical Care Medicine