title: A survey of blood pressure parameters after aneurysmal subarachnoid hemorrhage.
abstract: Purpose/aim: Blood pressure (BP) regulation is recommended following aneurysmal subarachnoid hemorrhage (aSAH) to prevent re-bleeding and to treat delayed cerebral ischemia. However, optimal BP thresholds are not well established. There is also variation with regard to the BP component (e.g. systolic vs. mean) that is targeted or manipulated.
  
  
  METHODS
  An 18-question survey was distributed to physicians and advanced practitioner members of the Neurocritical Care Society. Respondents were asked which BP parameter they manipulated and what their thresholds were in different clinical scenarios. They were also asked whether they were influenced by the presence of incidental aneurysms. Answers were analyzed for differences in training background and treatment setting.
  
  
  RESULTS
  There were 128 responses. The majority were neurointensivists (47 neurology and 37 non-neurology) and treated patients in dedicated neurointensive care units (n = 98). Systolic BP (SBP) was preferred over mean arterial pressure (MAP). Prior to aneurysm treatment, SBP limits ranged from 140 to 180 mm Hg. After aneurysm treatment, SBP limits ranged from 160 to 240 mm Hg. The maximum and minimum MAPs varied by as much as 50%. Nearly two-thirds of the respondents were influenced by the presence of incidental aneurysms. Training background influenced tolerance to BP limits with neurology-trained neurointensivists accepting higher BP limits when treating delayed ischemia ( p = .018). They were also more likely to follow SBP ( p = .018) and have a limit of 140 mm Hg prior to aneurysm treatment ( p = .001).
  
  
  CONCLUSIONS
  There is large practice variability in BP management following aSAH. There is also uncertainty over the importance of incidental aneurysms. Further research could evaluate whether this variability has clinical significance.
authors.affiliation: a Department of Surgery, Division of Critical Care , Hartford Hospital , Hartford , CT , USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brown
authors.affiliation: b Department of Neurology and Psychiatry , Saint Louis University , SaintLouis , MO , USA.
authors.forename: Abhay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: c Department of Neurology , University of Connecticut School of Medicine , Farmington , CT , USA.
authors.forename: Louise D
authors.initials: LD
authors.lastname: McCullough
authors.affiliation: a Department of Surgery, Division of Critical Care , Hartford Hospital , Hartford , CT , USA.
authors.forename: Karyn
authors.initials: K
authors.lastname: Butler
mesh_terms: D062186:Arterial Pressure / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D019468:Disease Management; D019538:Health Care Surveys; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000503:physiopathology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000503:physiopathology*
keywords: arterial blood pressure; cerebral aneurysm; delayed cerebral ischemia; neurointensivist; subarachnoid hemorrhage