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 Hemphill, David Menon, Lori Shutter, Paul Vespa, Nicolas Bruder, E. Sander Connolly, 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 TsengMervyn D.I. Vergouwen, Stefan Wolf, Gregory Zipfel

Research output: Contribution to journalReview articlepeer-review

527 Scopus citations

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 ofSAHto 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.

Original languageEnglish (US)
Pages (from-to)211-240
Number of pages30
JournalNeurocritical Care
Volume15
Issue number2
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

Keywords

  • Aneurysm
  • Anticonvulsants
  • Critical care
  • Endovascular
  • Fever
  • Hyponatremia
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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