scholarly journals Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital without neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Edoardo Picetti ◽  
Maurizio Berardino ◽  
Alessandro Bertuccio ◽  
Rita Bertuetti ◽  
Edoardo Pietro Boccardi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Interventional Neuroradiology ◽  
Italian Society ◽  
Early Management ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Specialized Center ◽  
Early Transfer

Abstract Background The immediate management of subarachnoid hemorrhage (SAH) patients in hospitals without neurosurgical/neurointerventional facilities and their transfer to a specialized center is challenging and not well covered in existing guidelines. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI) to provide clinical guidance. Methods A multidisciplinary consensus panel composed by 19 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different specializations (anesthesia/intensive care, neurosurgery and interventional neuroradiology) was created. A modified Delphi approach was adopted. Results A total of 14 statements have been discussed. Consensus was reached on 11 strong recommendations and 2 weak recommendations. In one case, where consensus could not be agreed upon, no recommendation could be provided. Conclusions Management of SAH in a non-specialized setting and early transfer are difficult and may have a critical impact on outcome. Clinical advice, based on multidisciplinary consensus, might be helpful. Our recommendations cover most, but not all, topics of clinical relevance.

Intensive care of aneurysmal subarachnoid hemorrhage: an international survey

2009 ◽  
Vol 35 (9) ◽  
pp. 1556-1566 ◽  
Author(s):  
Robert D. Stevens ◽  
Neeraj S. Naval ◽  
Marek A. Mirski ◽  
Giuseppe Citerio ◽  
Peter J. Andrews
Keyword(s):  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
International Survey

Early management of aneurysmal subarachnoid hemorrhage

1981 ◽  
Vol 54 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Harold P. Adams ◽  
Neal F. Kassell ◽  
James C. Torner ◽  
Donald W. Nibbelink ◽  
Adolph L. Sahs
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Medical Management ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Early Management ◽  
Neurological Sequelae ◽  
Content Type ◽  
Antifibrinolytic Therapy ◽  
Effective Reduction ◽  
Fine Print

✓ The overall results are presented of early medical management and delayed operation among 249 patients studied during the period 1974 to 1977, treated within 3 days of subarachnoid hemorrhage (SAH) and evaluated 90 days after aneurysm rupture. The results included 36.2% mortality, 17.9% survival with serious neurological sequelae, and 46% with a favorable outcome. Of the patients admitted in good neurological condition, 28.7% had died and only 55.7% had a favorable recovery at 90 days after SAH. These figures represent the results despite effective reduction in early rebleeding by antifibrinolytic therapy and successful surgery in those patients reaching operation. Further therapeutic advances are needed for patients hospitalized within a few days after SAH.

Does the subspecialty of an intensive care unit (ICU) has an impact on outcome in patients suffering from aneurysmal subarachnoid hemorrhage?

2018 ◽  
Vol 42 (1) ◽  
pp. 147-153
Author(s):  
Dorothee Mielke ◽  
Vesna Malinova ◽  
Onnen Moerer ◽  
Patricia Suntheim ◽  
Martin Voit ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage

Safety and Clinical Outcome of Good-Grade Aneurysmal Subarachnoid Hemorrhage in Non-Intensive Care Units

2020 ◽  
Vol 29 (10) ◽  
pp. 105123
Author(s):  
Clare Angeli G. Enriquez ◽  
Jose Danilo B. Diestro ◽  
Abdelsimar T. Omar ◽  
Romergryko G. Geocadin ◽  
Gerardo D. Legaspi
Keyword(s):  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Intensive Care Units ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Good Grade

scholarly journals Intensive care of traumatic brain injury and aneurysmal subarachnoid hemorrhage in Helsinki during the Covid-19 pandemic

2020 ◽  
Vol 162 (11) ◽  
pp. 2715-2724
Author(s):  
Teemu Luostarinen ◽  
Jyri Virta ◽  
Jarno Satopää ◽  
Minna Bäcklund ◽  
Riku Kivisaari ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Retrospective Review ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Case Mix

Abstract Background To ensure adequate intensive care unit (ICU) capacity for SARS-CoV-2 patients, elective neurosurgery and neurosurgical ICU capacity were reduced. Further, the Finnish government enforced strict restrictions to reduce the spread. Our objective was to assess changes in ICU admissions and prognosis of traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH) during the Covid-19 pandemic. Methods Retrospective review of all consecutive patients with TBI and aneurysmal SAH admitted to the neurosurgical ICU in Helsinki from January to May of 2019 and the same months of 2020. The pre-pandemic time was defined as weeks 1–11, and the pandemic time was defined as weeks 12–22. The number of admissions and standardized mortality rates (SMRs) were compared to assess the effect of the Covid-19 pandemic on these. Standardized mortality rates were adjusted for case mix. Results Two hundred twenty-four patients were included (TBI n = 123, SAH n = 101). There were no notable differences in case mix between TBI and SAH patients admitted during the Covid-19 pandemic compared with before the pandemic. No notable difference in TBI or SAH ICU admissions during the pandemic was noted in comparison with early 2020 or 2019. SMRs were no higher during the pandemic than before. Conclusion In the area of Helsinki, Finland, there were no changes in the number of ICU admissions or in prognosis of patients with TBI or SAH during the Covid-19 pandemic.

Target Serum Sodium Levels During Intensive Care Unit Management of Aneurysmal Subarachnoid Hemorrhage

Shock ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 558-563 ◽  
Author(s):  
Tomoya Okazaki ◽  
Toru Hifumi ◽  
Kenya Kawakita ◽  
Hajime Shishido ◽  
Daisuke Ogawa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Serum Sodium ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Unit Management ◽  
Intensive Care Unit Management

Early management of aneurysmal subarachnoid hemorrhage

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 412???8 ◽  
Author(s):  
B Ljunggren ◽  
L Brandt ◽  
G Sundb??rg ◽  
H S??veland ◽  
S Cronqvist ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Early Management

scholarly journals Trends in Mortality after Intensive Care of Patients with Aneurysmal Subarachnoid Hemorrhage in Finland in 2003–2019: A Finnish Intensive Care Consortium study

2021 ◽  
Author(s):  
Jyri J. Virta ◽  
Markus Skrifvars ◽  
Matti Reinikainen ◽  
Stepani Bendel ◽  
Ruut Laitio ◽  
...  
Keyword(s):  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Primary Outcome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Simplified Acute Physiology Score ◽  
World Federation ◽  
Multivariable Logistic Regression Model ◽  
Number Of Patients ◽  
The Mean ◽  
Case Mortality

Abstract Background Previous studies suggest that case mortality of aneurysmal subarachnoid hemorrhage (aSAH) has decreased during the last decades, but most studies have been unable to assess case severities among individual patients. We aimed to assess changes in severity-adjusted aSAH mortality in patients admitted to intensive care units (ICUs). Methods We conducted a retrospective, register-based study by using the prospectively collected Finnish Intensive Care Consortium database. Four out of five ICUs providing neurosurgical and neurointensive care in Finland participated in the Finnish Intensive Care Consortium. We extracted data on adult patients admitted to Finnish ICUs with aSAH between 2003 and 2019. The primary outcome was 12-month mortality during three periods: 2003–2008, 2009–2014, and 2015–2019. Using a multivariable logistic regression model—with variables including age, sex, World Federation of Neurological Surgeons grade, preadmission dependency, significant comorbidities, and modified Simplified Acute Physiology Score II—we analyzed whether admission period was independently associated with mortality. Results A total of 1,847 patients were included in the study. For the periods 2003–2008 and 2015–2019, the mean number of patients with aSAH admitted per year increased from 81 to 123. At the same time, the patients’ median age increased from 55 to 58 years (p = 0.001), and the proportion of patients with World Federation of Neurological Surgeons grades I–III increased from 42 to 58% (p < 0.001). The unadjusted 12-month mortality declined from 30% in 2003–2008 to 23% in 2015–2019 (p = 0.001), but there was no statistically significant change in severity-adjusted mortality. Conclusions Between 2003 and 2019, patients with aSAH admitted to ICUs became older and the proportion of less severe cases increased. Unadjusted mortality decreased but age and case severity adjusted–mortality remained unchanged.

scholarly journals Continental Survey of Access to Diagnostic Tools and Endovascular Management of Aneurysmal Subarachnoid Hemorrhage in Africa

2021 ◽  
Vol 8 ◽  
Author(s):  
Yao Christian Hugues Dokponou ◽  
Jay Kotecha ◽  
Soham Bandyopadhyay ◽  
Joshua Erhabor ◽  
Setthasorn Zhi Yang Ooi ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Interventional Neuroradiology ◽  
Health System Strengthening ◽  
Diagnostic Tools ◽  
Ct Scanner ◽  
African Countries ◽  
Conventional Angiography ◽  
Middle Income

Rationale: Interventional neurovascular procedures are effective in lowering the burden of mortality and complications resulting from aneurysmal subarachnoid hemorrhage (aSAH). Despite the wide uptake of interventional neurovascular procedures in high-income countries, access to care in low- and middle-income countries remains limited, and little is known about accessibility in Africa. In this survey, we decided to assess access to diagnostic tools and treatment of aSAH in Africa.Methodology: A Google form e-survey was distributed to African neurosurgery centers accepting responses from January 4th to March 21st 2021. Data on accessibility to diagnostic tools, treatment methodologies, and interventional neuroradiology personnel in African centers were collected. Ninety five percent confidence intervals were computed for each variable.Results: Data was received from 36 neurosurgical centers in 16 African countries (16/54, 30%). Most centers were public institutions. Ninety four percent of the centers had the necessary resources for a lumbar puncture (LP) and a laboratory for the diagnosis of aSAH. Most centers had at least one computed tomography (CT) scanner, 81% of the centers had access to CT angiography and some had access to conventional angiography. Forty seven percent of the centers could obtain a head CT within 2 h of presentation in an emergency. Sixty one percent of centers provided clipping of intracranial aneurysms whilst only 22% of centers could perform the endovascular treatment. Sixty four percent of centers did not have an endovascular specialist.Conclusion: This survey highlights health inequity in access to endovascular treatment for aSAH. Lack of diagnostic tools to identify an aneurysm and a shortfall of qualified endovascular specialists are prime reasons for this. Our findings can inform health system strengthening policies including the acquisition of equipment and capacity building in Africa.

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