Acute Multidisciplinary Management of Aneurysmal Subarachnoid Hemorrhage (aSAH)

Ran, Kathleen R.; Wang, Andrew C; Nair, Sumil K.; Akça, Ozan; Xu, Risheng

doi:10.4274/balkanmedj.galenos.2023.2023-1-100

Cited by 9 publications

(11 citation statements)

References 81 publications

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“…Not only can it alleviate the psychological pressure of patients, but compared to conventional nursing measures, it is more scientific, humane, and professional, ensuring the quality of nursing services. [17,18] The results of this study showed that the levels of stress response indicators in the Study-group were significantly lower than those in the Control-group, indicating that multidisciplinary management measures based on clinical nursing pathway models can help reduce the degree of stress response in patients with HICH. Conventional nursing measures lack sufficient attention to the patient psychological state, coupled with insufficient understanding of their own diseases and treatment measures, making them highly susceptible to severe negative emotions and exacerbating the degree of perioperative stress response; In a multidisciplinary management plan based on the clinical nursing pathway model, health education and psychological care can effectively regulate the patient physical and mental state, receive rehabilitation treatment in a good state, and reduce the degree of stress response.…”

Section: Discussionmentioning

confidence: 76%

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Multidisciplinary management based on clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage: A randomized controlled trial

Zhang,

Shen,

Zhou

et al. 2024

Medicine

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Objective: To explore the effectiveness of multidisciplinary management based on a clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage (HICH). Methods: A total of 124 patients with HICH admitted to our hospital between February 2021 and June 2023 were selected as research subjects in this randomized, controlled, unblinded study. They were divided into Control-group and Study-group using a random number table method, with 62 cases in each group. The Control-group received routine care and the Study-group adopted a multidisciplinary management approach based on the clinical nursing pathway model. A multidisciplinary intervention group including 1 attending physician, 1 psychotherapist, 1 nutritionist, 1 rehabilitation specialist, and 4 responsible nurses was constructed. From preoperative to postoperative day, patients were provided with psychological intervention, health education, respiratory tract management, and specific care for patients who were restless. One to 3 days after operation, the patients and their family members were guided in basic postoperative care and nutrition care. From the 4th day after surgery to the 1st day before discharge, patients were guided for rehabilitation exercises. Patients also received discharge advices upon discharge. Activities of daily living, neurological function, stress response indicators, incidence of complications, and nursing satisfaction before and after the intervention were compared between the 2 groups. Results: After the intervention, the activities of daily living and neurological function of the 2 groups were significantly improved compared to before the intervention, and the Study-group was significantly higher than the Control-group (P < .05). After intervention, the levels of stress response indicators in both groups significantly decreased compared to before the intervention, and the Study-group was significantly lower than the Control-group (P < .05). The incidence of complications in the Study-group (3.23%) was lower than that in the Control-group (15.00%) (P < .05). Nursing satisfaction in the Study-group (95.16%) was higher than that in the Control-group (83.33%) (P < .05). Conclusions: Our findings indicate that adopting a multidisciplinary management approach based on clinical nursing pathways to intervene in patients with HICH can reduce stress response levels, reduce the risk of complications, and facilitate the recovery of neurological function and activities of daily living with high patient satisfaction.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Multidisciplinary management based on clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage: A randomized controlled trial

Zhang,

Shen,

Zhou

et al. 2024

Medicine

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“…19,20 En nuestra población de estudio, la localización más común del aneurisma fue en la arteria comunicante anterior (40.9%), esto está acorde con algunos estudios que muestra una mayor de incidencia de aneurismas en este sitio; 2,4,6 sin embargo, cabe mencionar que existe variación en la literatura respecto a la localización más común de los aneurismas, lo que puede deberse a factores genéticos o raciales. 21 El porcentaje de pacientes que requirieron intubación y ventilación mecánica fue elevado, lo que podría estar relacionado con el grado de severidad de la hemorragia 1,6,22 o con criterios de manejo por los médicos tratantes del servicio. La escala de Fisher que mostró una mayor proporción de casos fueron categorías III y IV, lo que fisiopatológicamente se asocian a un peor pronóstico y a un mayor riesgo de vasoespasmo.…”

Section: Discussionunclassified

“…24 Respecto al destino y desenlace de los pacientes, se observó que la mayoría fueron enviados a la unidad de cuidados intensivos o a la sala de operaciones, lo que refleja la necesidad de un manejo especializado y multidisciplinario para estos casos. 4,7,22 La tasa de mortalidad a los 28 días de seguimiento fue del 18.2%, este porcentaje de mortalidad fue menor al promedio reportado que oscila entre el 10 -50% que depende de muchos factores, lo que se corresponde con la gravedad de la HSA y con los datos reportados en otros países. 6,25 Los factores que podrían influir en la mortalidad son el grado de sangrado, el nivel de conciencia, la edad, las comorbilidades, el vasoespasmo y el tipo de tratamiento.…”

Section: Discussionunclassified

Hemorragia subaracnoidea aneurismática en un centro privado de Lima, Perú

Ayala-García,

Álvarez-Carranza

2023

Interciencia méd.

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La hemorragia subaracnoidea aneurismática es una afección neurológica crítica. Este estudio describe la presentación clínica y el manejo de HSA en un centro médico privado en Lima, Perú, entre 2019 y 2021, comparando los resultados con la literatura nacional e internacional. Se observó una menor incidencia de casos en 2020 - 2021, posiblemente debiado a la pandemia COVID - 19. La mediana de edad fue de 54 años, con predominancia femenina. La hipertensión arterial fue la comorbilidad más común. La presentación clínica más habitual fue cefalea. En cuanto al tratamiento, el clipaje fue el método más utilizado. La tasa de mortalidad a los 28 días fue del 18.2%. A pesar de sus limitaciones, como un tamaño muestral reducido, el estudio proporciona información clínica valiosa sobre la HSA en una institución médica privada y es coherente con hallazgos internacionales. Se enfatiza la necesidad de más investigaciones para mejorar el tratamiento y manejo de HSA.

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“…Aneurysmal subarachnoid hemorrhage (aSAH) is a highly aggressive subtype of acute stroke that leads to loss of life in approximately 30% of patients, with 50% of survivors potentially unable to regain full functional independence [ 1 , 2 , 3 ]. Unfortunately, aSAH is prone to occur in adulthood (median age 55) when an individual in the general population is likely to have a good life expectancy and be at the height of their careers [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Pre- and Post-Operative Online Prediction of Outcome in Patients Undergoing Endovascular Coiling after Aneurysmal Subarachnoid Hemorrhage: Visual and Dynamic Nomograms

et al. 2023

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Background: Aneurysmal subarachnoid hemorrhage (aSAH) causes long-term functional dependence and death. Early prediction of functional outcomes in aSAH patients with appropriate intervention strategies could lower the risk of poor prognosis. Therefore, we aimed to develop pre- and post-operative dynamic visualization nomograms to predict the 1-year functional outcomes of aSAH patients undergoing coil embolization. Methods: Data were obtained from 400 aSAH patients undergoing endovascular coiling admitted to the People’s Hospital of Hunan Province in China (2015–2019). The key indicator was the modified Rankin Score (mRS), with 3–6 representing poor functional outcomes. Multivariate logistic regression (MLR)-based visual nomograms were developed to analyze baseline characteristics and post-operative complications. The evaluation of nomogram performance included discrimination (measured by C statistic), calibration (measured by the Hosmer–Lemeshow test and calibration curves), and clinical usefulness (measured by decision curve analysis). Results: Fifty-nine aSAH patients (14.8%) had poor outcomes. Both nomograms showed good discrimination, and the post-operative nomogram demonstrated superior discrimination to the pre-operative nomogram with a C statistic of 0.895 (95% CI: 0.844–0.945) vs. 0.801 (95% CI: 0.733–0.870). Each was well calibrated with a Hosmer–Lemeshow p-value of 0.498 vs. 0.276. Moreover, decision curve analysis showed that both nomograms were clinically useful, and the post-operative nomogram generated more net benefit than the pre-operative nomogram. Web-based online calculators have been developed to greatly improve the efficiency of clinical applications. Conclusions: Pre- and post-operative dynamic nomograms could support pre-operative treatment decisions and post-operative management in aSAH patients, respectively. Moreover, this study indicates that integrating post-operative variables into the nomogram enhanced prediction accuracy for the poor outcome of aSAH patients.

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Acute Multidisciplinary Management of Aneurysmal Subarachnoid Hemorrhage (aSAH)

Cited by 9 publications

References 81 publications

Multidisciplinary management based on clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage: A randomized controlled trial

Multidisciplinary management based on clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage: A randomized controlled trial

Hemorragia subaracnoidea aneurismática en un centro privado de Lima, Perú

Pre- and Post-Operative Online Prediction of Outcome in Patients Undergoing Endovascular Coiling after Aneurysmal Subarachnoid Hemorrhage: Visual and Dynamic Nomograms

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