Medically induced hypertension, hypervolaemia and haemodilution for the treatment and prophylaxis of vasospasm following aneurysmal subarachnoid haemorrhage: systematic review

Loan, James J M; Wiggins, Anthony; Brennan, Paul M.

doi:10.1080/02688697.2018.1426720

Cited by 27 publications

(22 citation statements)

References 43 publications

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“…16,23 Consequently, intravenous volume expansion is widely used to treat and prevent delayed cerebral ischaemia after SAH, although efficacy has not yet been demonstrated. 24,25 Our study has the advantage of a high response rate with representation from 31 of 32 (97%) adult neurosurgical units in the UK and Ireland. We did not assess intra-unit variability, but asked units to give a consensus of their usual practice and it is possible that there is within unit as well as between unit variability in investigation and management.…”

Section: Discussionmentioning

confidence: 99%

Investigation and management of serum sodium after subarachnoid haemorrhage (SaSH): a survey of practice in the United Kingdom and Republic of Ireland

Tominey

Baweja

Woodfield

et al. 2021

British Journal of Neurosurgery

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Background: Hyponatraemia is a common complication of aneurysmal subarachnoid haemorrhage (SAH). We aimed to determine current neurosurgical practice for the identification, investigation and management of hyponatraemia after SAH. Methods: An online questionnaire was completed by UK and Irish neurosurgical trainees and consultant collaborators in the Sodium after Subarachnoid Haemorrhage (SaSH) audit. Results: Between August 2019 and June 2020, 43 responses were received from 31 of 32 UK and Ireland adult neurosurgical units (NSUs). All units reported routine measurement of serum sodium either daily or every other day. Most NSUs reported routine investigation of hyponatraemia after SAH with paired serum and urinary osmolalities (94%), urinary sodium (84%), daily fluid balance (84%), but few measured glucose (19%), morning cortisol (13%), or performed a short Synacthen test (3%). Management of hyponatraemia was variable, with units reporting use of oral sodium supplementation (77%), fluid restriction (58%), hypertonic saline (55%), and fludrocortisone (19%). Conclusions: Reported assessment of serum sodium after SAH was consistent between units, whereas management of hyponatraemia varied. This may reflect the lack of a specific evidence-base to inform practice.

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Section: Discussionmentioning

confidence: 99%

Investigation and management of serum sodium after subarachnoid haemorrhage (SaSH): a survey of practice in the United Kingdom and Republic of Ireland

Tominey

Baweja

Woodfield

et al. 2021

British Journal of Neurosurgery

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“…Systematic reviews and metaanalyses are also available. [26][27][28][29] Interventions include both systemic 27 and local 2628,29 endovascular treatments aiming at improving cerebral perfusion and oxygen delivery. Our algorithm is detailed in Figures 1 and 2.…”

Section: Diagnosis and Management Of DCImentioning

confidence: 99%

How do I manage cerebral vasospasm and delayed cerebral ischemia?

Gaspard

2020

Minerva Anestesiol

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“…However, it is associated with significant complications and the current literature does not support its use. 29,46,47 Of the components, hypertensive therapy has the most supporting evidence. 27,39,48,49 A recent retrospective observational study of 300 patients with DCI found that hypertensive therapy was associated with a reduction in both cerebral infarcts and poor clinical outcomes.…”

Section: Management Of Vasospasm and Delayed Cerebral Ischemiamentioning

confidence: 99%

Contemporary Management of Aneurysmal Subarachnoid Hemorrhage: A Literature Review

Yeo

Terrett

Gupta

2019

Journal of Neuroanaesthesiology and Critical Care

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Subarachnoid hemorrhage (SAH) results in significant morbidity and mortality, which leads to additional economic and psychological burden. Atraumatic SAH is normally secondary to a ruptured aneurysm. Diagnosis of aneurysmal subarachnoid hemorrhage (aSAH) is usually made by computed tomography (CT) of the head: noncontrast CT identifies the hemorrhage, and CT angiography identifies the aneurysm.The management of aSAH is focused on securing the aneurysm and prevention of secondary brain injury. Definitive treatment of the aneurysm is done by endovascular coiling or surgical clipping, which should be performed as soon as possible with avoidance of hypertension and strict blood pressure management prior to aneurysm securement. Routine use of nimodipine is recommended by international guidelines as a neuroprotectant. Common neurological complications of aSAH are hydrocephalus, seizures, vasospasm, and delayed cerebral ischemia (DCI). Detection of DCI, especially in patients with poor-grade aSAH, can be challenging. In addition to clinical examination, multiple radiological modalities can be used, with digital subtraction angiography being the gold standard but CT perfusion gaining an increasingly important role. Extracranial complications including cardiac dysfunction, pulmonary edema, and electrolyte abnormalities are common, causing significant morbidity and mortality.In this review, a PubMed literature search was conducted using the terms “subarachnoid hemorrhage” and “management,” with results limited to past 5 years. Journal articles were hand-selected by the authors based on relevance, and the references were reviewed to identify additional relevant publications. Historically important publications were also included.

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Medically induced hypertension, hypervolaemia and haemodilution for the treatment and prophylaxis of vasospasm following aneurysmal subarachnoid haemorrhage: systematic review

Cited by 27 publications

References 43 publications

Investigation and management of serum sodium after subarachnoid haemorrhage (SaSH): a survey of practice in the United Kingdom and Republic of Ireland

Investigation and management of serum sodium after subarachnoid haemorrhage (SaSH): a survey of practice in the United Kingdom and Republic of Ireland

How do I manage cerebral vasospasm and delayed cerebral ischemia?

Contemporary Management of Aneurysmal Subarachnoid Hemorrhage: A Literature Review

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