Hemodynamic Management in the Prevention and Treatment of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

One of the most serious complications after subarachnoid hemorrhage (SAH) is delayed cerebral ischemia, the cause of which is multifactorial. Delayed cerebral ischemia considerably worsens neurological outcome and increases the risk of death. The targets of hemodynamic management of SAH have widely...

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Bibliographic Details
Published in:Neurocritical care 2023-08, Vol.39 (1), p.81-90
Main Authors: Deem, Steven, Diringer, Michael, Livesay, Sarah, Treggiari, Miriam M.
Format: Article
Language:English
Subjects:
Aneurysms
Antihypertensives
Blood pressure
Critical Care Medicine
Diuretics
Hemodynamics
Hemorrhage
Hypertension
Hyponatremia
Hypotension
Intensive
Internal Medicine
Ischemia
Medicine
Medicine & Public Health
Mortality
Neurology
Neurosurgery
Practice Guidance for Critical Care Management of SAH
Prevention
Pulmonary arteries
Surgery
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Summary:One of the most serious complications after subarachnoid hemorrhage (SAH) is delayed cerebral ischemia, the cause of which is multifactorial. Delayed cerebral ischemia considerably worsens neurological outcome and increases the risk of death. The targets of hemodynamic management of SAH have widely changed over the past 30 years. Hypovolemia and hypotension were favored prior to the era of early aneurysmal surgery but were subsequently replaced by the use of hypervolemia and hypertension. More recently, the concept of goal-directed therapy targeting euvolemia, with or without hypertension, is gaining preference. Despite the evolving concepts and the vast literature, fundamental questions related to hemodynamic optimization and its effects on cerebral perfusion and patient outcomes remain unanswered. In this review, we explain the rationale underlying the approaches to hemodynamic management and provide guidance on contemporary strategies related to fluid administration and blood pressure and cardiac output manipulation in the management of SAH.
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-023-01738-w