Critical care of aneurysmal subarachnoid hemorrhage: State of the art

Subarachnoid hemorrhage (SAH) from a ruptured aneurysm is a very complex disease. The brain can be injured from the immediate effects of the acute bleeding, but can also be threatened by secondary insults hours and days later. Early and delayed systemic complications are common and can be very serious. This brief paper summarizes key practical concepts regarding the neurocritical care of patients with aneurysmal SAH (aSAH). It proposes as a framework the division of the time course of the disease into a fi rst phase (from aneurysm rupture to aneurysm treatment) of resuscitation and stabilization and a second phase (from aneurysm treatment to the end of the acute hospitalization) of prevention and treatment of secondary insults. The main mechanisms of cerebral injury and the principal systemic complications are discussed and diagnostic and therapeutic advice is provided based on a combination of available evidence and clinical experience.