title: Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference.
abstract: Subarachnoid hemorrhage (SAH) is an acute cerebrovascular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs. SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team. A lack of high quality data has led to numerous approaches to management and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of rebleeding, but provide limited discussion of the complex critical care issues involved in the care of SAH patients. The Neurocritical Care Society organized an international, multidisciplinary consensus conference on the critical care management of SAH to address this need. Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise. A jury of four experienced neurointensivists was selected for their experience in clinical investigations and development of practice guidelines. Recommendations were developed based on literature review using the GRADE system, discussion integrating the literature with the collective experience of the participants and critical review by an impartial jury. Recommendations were developed using the GRADE system. Emphasis was placed on the principle that recommendations should be based not only on the quality of the data but also tradeoffs and translation into practice. Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data.
authors.affiliation: Neurology/Neurosurgery Intensive Care Unit, Washington University, St. Louis, MO, USA. diringerm@neuro.wustl.edu
authors.forename: Michael N
authors.initials: MN
authors.lastname: Diringer
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Bleck
authors.forename: J
authors.initials: J
authors.lastname: Claude Hemphill
authors.forename: David
authors.initials: D
authors.lastname: Menon
authors.forename: Lori
authors.initials: L
authors.lastname: Shutter
authors.forename: Paul
authors.initials: P
authors.lastname: Vespa
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bruder
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
authors.forename: Daryl
authors.initials: D
authors.lastname: Gress
authors.forename: Daniel
authors.initials: D
authors.lastname: Hänggi
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hoh
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: Peter
authors.initials: P
authors.lastname: Le Roux
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rabinstein
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
authors.forename: Nino
authors.initials: N
authors.lastname: Stocchetti
authors.forename: Jose I
authors.initials: JI
authors.lastname: Suarez
authors.forename: Miriam
authors.initials: M
authors.lastname: Treggiari
authors.forename: Ming-Yuan
authors.initials: MY
authors.lastname: Tseng
authors.forename: Mervyn D I
authors.initials: MD
authors.lastname: Vergouwen
authors.forename: Stefan
authors.initials: S
authors.lastname: Wolf
authors.forename: Gregory
authors.initials: G
authors.lastname: Zipfel
mesh_terms: D000208:Acute Disease; D003422:Critical Care / Q000592:standards*; D006801:Humans; D015994:Incidence; D055502:Secondary Prevention; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000628:therapy*; D020301:Vasospasm, Intracranial / Q000401:mortality* / Q000628:therapy*