title: Review and recommendations on management of refractory raised intracranial pressure in aneurysmal subarachnoid hemorrhage.
abstract: Intracranial hypertension is commonly encountered in poor-grade aneurysmal subarachnoid hemorrhage patients. Refractory raised intracranial pressure is associated with poor prognosis. The management of raised intracranial pressure is commonly referenced to experiences in traumatic brain injury. However, pathophysiologically, aneurysmal subarachnoid hemorrhage is different from traumatic brain injury. Currently, there is a paucity of consensus on the management of refractory raised intracranial pressure in spontaneous subarachnoid hemorrhage. We discuss in this paper the role of hyperosmolar agents, hypothermia, barbiturates, and decompressive craniectomy in managing raised intracranial pressure refractory to first-line treatment, in which preliminary data supported the use of hypertonic saline and secondary decompressive craniectomy. Future clinical trials should be carried out to delineate better their roles in management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage patients.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Calvin Hoi Kwan
authors.initials: CH
authors.lastname: Mak
authors.forename: Yeow Yuen
authors.initials: YY
authors.lastname: Lu
authors.forename: George Kwok Chu
authors.initials: GK
authors.lastname: Wong
mesh_terms: D001463:Barbiturates / Q000627:therapeutic use*; D003128:Coma; D056424:Decompressive Craniectomy / Q000592:standards; D005440:Fluid Therapy / Q000592:standards; D006801:Humans; D006982:Hypertonic Solutions; D007036:Hypothermia, Induced / Q000592:standards; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007427:Intracranial Pressure / Q000187:drug effects*; D008353:Mannitol / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D012965:Sodium Chloride / Q000008:administration & dosage; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D001463:Barbiturates; D006982:Hypertonic Solutions; D008353:Mannitol; D012965:Sodium Chloride
keywords: aneurysm; intracranial hypertension; intracranial pressure; subarachnoid hemorrhage