NYMC Faculty Publications
Neurocritical Care Management of Poor-Grade Subarachnoid Hemorrhage: Unjustified Nihilism to Reasonable Optimism
Author Type(s)
Faculty
DOI
10.1177/19714009211024633
Journal Title
The Neuroradiology Journal
First Page
542
Last Page
551
Document Type
Review Article
Publication Date
12-2021
Department
Neurosurgery
Second Department
Neurology
Abstract
BACKGROUND AND PURPOSE: Historically, overall outcomes for patients with high-grade subarachnoid hemorrhage (SAH) have been poor. Generally, between physicians, either reluctance to treat, or selectivity in treating such patients has been the paradigm. Recent studies have shown that early and aggressive care leads to significant improvement in survival rates and favorable outcomes of grade V SAH patients. With advancements in both neurocritical care and end-of-life care, non-treatment or selective treatment of grade V SAH patients is rarely justified. Current paradigm shifts towards early and aggressive care in such cases may lead to improved outcomes for many more patients.
MATERIALS AND METHODS: We performed a detailed review of the current literature regarding neurointensive management strategies in high-grade SAH, discussing multiple aspects. We discussed the neurointensive care management protocols for grade V SAH patients.
RESULTS: Acutely, intracranial pressure control is of utmost importance with external ventricular drain placement, sedation, optimization of cerebral perfusion pressure, osmotherapy and hyperventilation, as well as cardiopulmonary support through management of hypotension and hypertension.
CONCLUSIONS: Advancements of care in SAH patients make it unethical to deny treatment to poor Hunt and Hess grade patients. Early and aggressive treatment results in a significant improvement in survival rate and favorable outcome in such patients.
Recommended Citation
Al-Mufti, F., Mayer, S. A., Kaur, G., Bassily, D., Li, B., Holstein, M. L., Ani, J., Matluck, N. E., Kamal, H., Nuoman, R., Bowers, C. A., Ali, F. S., Al-Shammari, H., El-Ghanem, M., Gandhi, C., & Amuluru, K. (2021). Neurocritical Care Management of Poor-Grade Subarachnoid Hemorrhage: Unjustified Nihilism to Reasonable Optimism. The Neuroradiology Journal, 34 (6), 542-551. https://doi.org/10.1177/19714009211024633