Intracranial Pressure Monitoring in Poor-Grade Patients with Aneurysmal Subarachnoid Hemorrhage Treated by Coiling

Imberti, Roberto; Picetti, Edoardo; Rossi, Sandra; Capaccio, Emanuele; Accetta, Giovanni; Klersy, Catherine; Lafe, Elvis; Pietrobono, Luigi; Cimino, Francesco; Frattini, Lara; Grappa, Elena; Casagli, Sergio; Crobeddu, Emanuela; Iotti, Giorgio

doi:10.1016/j.wneu.2021.09.018

Cited by 6 publications

(2 citation statements)

References 23 publications

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“…The main difficulty that the doctors face related to patients that are suffering from SAH is to determine the maximum blood glucose target that is achieved after the severe brain injury. Hyperglycemia if it prevails for a longer period of time can cause severe negative side effects in patients that promote other destructive processes by up regulating their feedback mechanisms 16 . Therefore, there is a need to control the blood glucose level as soon as it gets out of control.…”

Section: Discussionmentioning

confidence: 99%

Effective Management of Hyperglycemia Improve the Outcome of Aneurysmal Subarachnoid Hemorrhage

Hashim¹

2022

PJMHS

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Aneurysmal subarachnoid hemorrhage is one of the most commonly known life-threating disease. Many neurological outcomes are associated with SAH. The poor outcomes are associated with the hyperglycemia in the aneurysmal subarachnoid hemorrhage patients. The major risk factor associated with the aneurysmal subarachnoid hemorrhage is hyperglycemia. Objective: The purpose of this research work was to get in-depth understanding of the effect of glycemic control on changes in the outcomes associated aneurysmal subarachnoid hemorrhage. Study design: It is a prospective study with the statistical approach, conducted at Department of Neurology, Fauji Foundation Hospital, Rawalpindi. Methods: The 365 patients visited the neurology department of our institute were included in the study. The duration of this study was March 2020 March 2022. The 56 ± 14 years was the mean age of the patients included in this study. The 106 (29%) out of 365 were male candidates. The half of the patients were treated with the aggressive hyperglycemic management AHM protocol, while other half were treated with the standard glycemic management SGM protocols. The patients was labelled with good glycemic outcome if the mean glucose burden is less than 1.1, and labelled as poor outcome if mean glucose burden is greater than 1.1. The outcomes of the AHM and SGM group were compared. Different logistic regression models were used to quantify the poor outcome effects. Results: The result depicted that the patients treated with the AHM protocols showed lower poor outcomes (28%) as compared to the other treated with SGM. The values remain insignificant after correction of temporal trends. The incidence of the poor outcome can be reduced by the good glycemic control. The clinical vasospasm rates remain same before or after the implementation of AHM controls. Conclusion: The poor outcomes associated with the SAH can be reduced by good glycemic control of the patients. The study depicted the not only the blood glucose level will remain in the range but also better neurological health of the patients’ will be promoted by an effective use of aggressive glucose management on the patients suffering from SAH. Keywords: Aneurysmal subarachnoid hemorrhage, AHM glycemic control, Hyperglycemic outcomes, Vasospasm, logistic regression models.

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Section: Discussionmentioning

confidence: 99%

Effective Management of Hyperglycemia Improve the Outcome of Aneurysmal Subarachnoid Hemorrhage

Hashim¹

2022

PJMHS

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“…Episodes of elevated ICP and reduced CPP have been recently observed during endovascular coiling and could be associated with poor neurological outcomes [16]. Although more data are needed on this topic, we recommend ICP monitoring during endovascular coiling when an EVD has been inserted before aneurysm/s management.…”

Section: Icp Monitoring During Endovascular Coiling and Cpp Managementmentioning

confidence: 91%

Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)–Part 1

Picetti

Barbanera

Bernucci

et al. 2022

J Anesth Analg Crit Care

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Background Issues remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI). In this manuscript, we aim to provide a list of experts’ recommendations regarding the early management of SAH patients from hospital admission, in a center with neurosurgical/neuro-endovascular facilities, until securing of the bleeding aneurysm. Methods A multidisciplinary consensus panel composed of 24 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different background (anesthesia/intensive care, neurosurgery, and interventional neuroradiology) was created. A modified Delphi approach was adopted. Results Among 19 statements discussed. The consensus was reached on 18 strong recommendations. In one case, consensus could not be agreed upon and no recommendation was provided. Conclusions This consensus provides practical recommendations for the management of SAH patients in hospitals with neurosurgical/neuroendovascular facilities until aneurysm securing. It is intended to support clinician’s decision-making and not to mandate a standard of practice.

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