Postinterventional critical care management of aneurysmal subarachnoid hemorrhage

Sudhir Datar, Alejandro Rabinstein

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Purpose of review Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects. Recent findings Growing body of evidence highlights the usefulness of CT perfusion scans in the diagnosis of vasospasm and delayed cerebral ischemia (DCI). Hypervolemia leads to worse cardiopulmonary outcomes and does not improve DCI. The traditional triple H therapy is falling out of favor with hemodynamic augmentation alone now considered the mainstay of medical management. Randomized controlled trials have shown that simvastatin and intravenous magnesium do not prevent DCI or improve functional outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Emerging data using multimodality monitoring has further advanced our understanding of the pathophysiology of DCI in poor grade aSAH. Summary The brief review will focus on the postinterventional care of aSAH patients outlining the recent advances over the past few years.

Original languageEnglish (US)
Pages (from-to)87-93
Number of pages7
JournalCurrent Opinion in Critical Care
Volume23
Issue number2
DOIs
StatePublished - Apr 1 2017

Fingerprint

Subarachnoid Hemorrhage
Critical Care
Brain Ischemia
Accidental Falls
Ruptured Aneurysm
Simvastatin
Delayed Diagnosis
Magnesium
Randomized Controlled Trials
Perfusion
Hemodynamics
Brain
Research

Keywords

  • aneurysm
  • cerebral salt wasting
  • delayed cerebral ischemia
  • postinterventional care
  • subarachnoid hemorrhage
  • vasospasm

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Postinterventional critical care management of aneurysmal subarachnoid hemorrhage. / Datar, Sudhir; Rabinstein, Alejandro.

In: Current Opinion in Critical Care, Vol. 23, No. 2, 01.04.2017, p. 87-93.

Research output: Contribution to journalReview article

@article{6c74d85f40f748c78f3da6d9ee1b23bf,
title = "Postinterventional critical care management of aneurysmal subarachnoid hemorrhage",
abstract = "Purpose of review Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects. Recent findings Growing body of evidence highlights the usefulness of CT perfusion scans in the diagnosis of vasospasm and delayed cerebral ischemia (DCI). Hypervolemia leads to worse cardiopulmonary outcomes and does not improve DCI. The traditional triple H therapy is falling out of favor with hemodynamic augmentation alone now considered the mainstay of medical management. Randomized controlled trials have shown that simvastatin and intravenous magnesium do not prevent DCI or improve functional outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Emerging data using multimodality monitoring has further advanced our understanding of the pathophysiology of DCI in poor grade aSAH. Summary The brief review will focus on the postinterventional care of aSAH patients outlining the recent advances over the past few years.",
keywords = "aneurysm, cerebral salt wasting, delayed cerebral ischemia, postinterventional care, subarachnoid hemorrhage, vasospasm",
author = "Sudhir Datar and Alejandro Rabinstein",
year = "2017",
month = "4",
day = "1",
doi = "10.1097/MCC.0000000000000391",
language = "English (US)",
volume = "23",
pages = "87--93",
journal = "Current Opinion in Critical Care",
issn = "1070-5295",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Postinterventional critical care management of aneurysmal subarachnoid hemorrhage

AU - Datar, Sudhir

AU - Rabinstein, Alejandro

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Purpose of review Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects. Recent findings Growing body of evidence highlights the usefulness of CT perfusion scans in the diagnosis of vasospasm and delayed cerebral ischemia (DCI). Hypervolemia leads to worse cardiopulmonary outcomes and does not improve DCI. The traditional triple H therapy is falling out of favor with hemodynamic augmentation alone now considered the mainstay of medical management. Randomized controlled trials have shown that simvastatin and intravenous magnesium do not prevent DCI or improve functional outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Emerging data using multimodality monitoring has further advanced our understanding of the pathophysiology of DCI in poor grade aSAH. Summary The brief review will focus on the postinterventional care of aSAH patients outlining the recent advances over the past few years.

AB - Purpose of review Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects. Recent findings Growing body of evidence highlights the usefulness of CT perfusion scans in the diagnosis of vasospasm and delayed cerebral ischemia (DCI). Hypervolemia leads to worse cardiopulmonary outcomes and does not improve DCI. The traditional triple H therapy is falling out of favor with hemodynamic augmentation alone now considered the mainstay of medical management. Randomized controlled trials have shown that simvastatin and intravenous magnesium do not prevent DCI or improve functional outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Emerging data using multimodality monitoring has further advanced our understanding of the pathophysiology of DCI in poor grade aSAH. Summary The brief review will focus on the postinterventional care of aSAH patients outlining the recent advances over the past few years.

KW - aneurysm

KW - cerebral salt wasting

KW - delayed cerebral ischemia

KW - postinterventional care

KW - subarachnoid hemorrhage

KW - vasospasm

UR - http://www.scopus.com/inward/record.url?scp=85011854064&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011854064&partnerID=8YFLogxK

U2 - 10.1097/MCC.0000000000000391

DO - 10.1097/MCC.0000000000000391

M3 - Review article

C2 - 28169856

AN - SCOPUS:85011854064

VL - 23

SP - 87

EP - 93

JO - Current Opinion in Critical Care

JF - Current Opinion in Critical Care

SN - 1070-5295

IS - 2

ER -