Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome

Journal of Intensive Care
Tomoya Okazaki, Yasuhiro Kuroda

Abstract

Aneurysmal subarachnoid hemorrhage is a life-threatening disease requiring neurocritical care. Delayed cerebral ischemia is a well-known complication that contributes to unfavorable neurological outcomes. Cerebral vasospasm has been thought to be the main cause of delayed cerebral ischemia, and although several studies were able to decrease cerebral vasospasm, none showed improved neurological outcomes. Our target is not cerebral vasospasm but improving neurological outcomes. The purpose of this review is to discuss what intensivists should know and can do to improve clinical outcomes in subarachnoid hemorrhage patients. Delayed cerebral ischemia is thought to be due to not only vasospasm but also multifactorial mechanisms. Additionally, the concept of early brain injury, which occurs within the first 72 h after the hemorrhage, has become an important concern. Increasing sympathetic activity after the hemorrhage is associated with cardiopulmonary complications and poor outcomes. Serum lactate measurement may be a valuable marker reflecting the severity of sympathetic activity. The transpulmonary thermodilution method will bring about an advanced understanding of hemodynamic management. Fever is a well-recognized symptom and tar...Continue Reading

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Citations

Aug 23, 2019·Annals of Intensive Care·Bruno GonçalvesFernando Augusto Bozza
Jul 10, 2020·Stroke; a Journal of Cerebral Circulation·Aida AnetsbergerBettina Jungwirth
Jan 29, 2020·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Harsh Sapra
Jul 31, 2020·Qatar Medical Journal·Dr Adnan KhanDr Ali Ayyad

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