Top

Intensive Care Medicine

Published in:

01-09-2007 | Original

Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers

Authors: Guiseppe Citerio, Sergio M. Gaini, Guistino Tomei, Nino Stocchetti

Published in: Intensive Care Medicine | Issue 9/2007

Abstract

Objective

To collect information on clinical practice and current management strategies in 22 Italian neurosurgical hospitals for patients with aneurysmal subarachnoid hemorrhage.

Design and setting

Observational 6-month study for prospective data collection.

Patients

350 cases of aneurysmal subarachnoid hemorrhage.

Measurements and results

Each center enrolled from 4–36 patients. Neurological deterioration (24%) was more frequent in patients with higher Fisher classification, and with pretreatment rebleeding and it was associated with an unfavorable outcome (46%, 36/78, vs. 33%, 83/251). Aneurysms were mainly secured by clipping (55%, 191/350). An endovascular approach was utilized in 35% (121/350). The more frequent medical complications were fever, recorded in one-half of cases, pneumonia (18%), sodium disturbances (hyponatremia 22%, hypernatremia 17%), cardiopulmonary events as neurogenic pulmonary edema (4%) and myocardial ischemia (5%). Intracranial hypertension was experienced in one-third of the patients, followed by hydrocephalus (29%) and vasospasm (30%). Cerebral ischemia was found in an about one-quarter of the cohort. To identify the independent predictors of outcome we developed a model in which the dichotomized Glasgow Outcome Scale was tested as function of extracranial and intracranial complications. Only high intracranial pressure and deterioration in neurological status were independent factors related to unfavorable outcome.

Conclusions

Our data confirm that in every step of care there is extreme heterogeneity among centers. These patients are complex, with comorbidities, immediate risk of rebleeding, and delayed risk of intracranial and medical complications. Following SAH early treatment and careful intensive care management requires the careful coordination of the various clinical specialties.

Gijn J van, Rinkel GJ (2001) Subarachnoid haemorrhage: diagnosis, causes and management. Brain 124:249–278CrossRef

Suarez JI, Tarr RW, Selman WR (2006) Aneurysmal subarachnoid hemorrhage. N Engl J Med 354:387–396PubMedCrossRef

Naval NS, Stevens RD, Mirski MA, Bhardwaj A (2006) Controversies in the management of aneurysmal subarachnoid hemorrhage. Crit Care Med 34:511–524PubMedCrossRef

Al-Shahi R, White PM, Davenport RJ, Lindsay KW (2006) Subarachnoid haemorrhage. BMJ 333:235–240PubMedCrossRef

Citerio G, Gallizzi F, Cazzaniga S, Galli D, Patruno A, Sganzerla E (2005) Management Of aneurysmal subarachnoid hemorrhage: time for practical guidelines. Intensive Care Med 31[Suppl 1]:315

Citerio G, Stocchetti N, Cormio M, Beretta L (2000) Neuro-Link, a computer-assisted database for head injury in intensive care. Acta Neurochir (Wien) 142:769–776CrossRef

Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20PubMed

Drake C (1988) Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 68:985–986

Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1:1–9CrossRef

10.

Okada Y, Shima T, Nishida M, Yamane K, Hatayama T, Yamanaka C, Yoshida A (1999) Comparison of transcranial Doppler investigation of aneurysmal vasospasm with digital subtraction angiographic and clinical findings. Neurosurgery 45:443–449PubMedCrossRef

11.

Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet I:480–484CrossRef

12.

Janjua N, Mayer SA (2003) Cerebral vasospasm after subarachnoid hemorrhage. Curr Opin Crit Care 9:113–119PubMedCrossRef

13.

Sen J, Belli A, Albon H, Morgan L, Petzold A, Kitchen N (2003) Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage. Lancet Neurol 2:614–621PubMedCrossRef

14.

Sakowitz OW, Raabe A, Vucak D, Kiening KL, Unterberg AW (2006) Contemporary management of aneurysmal subarachnoid hemorrhage in Germany: results of a survey among 100 neurosurgical departments. Neurosurgery 58:137–145PubMedCrossRef

15.

Bardach NS, Zhao S, Gress DR, Lawton MT, Johnston SC (2002) Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke 33:1851–1856PubMedCrossRef

16.

Cross DT 3rd, Tirschwell DL, Clark MA, Tuden D, Derdeyn CP, Moran CJ, Dacey RG Jr (2003) Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states. J Neurosurg 99:810–817PubMedCrossRef

17.

Berman MF, Solomon RA, Mayer SA, Johnston SC, Yung PP (2003) Impact of hospital-related factors on outcome after treatment of cerebral aneurysms. Stroke 34:2200–2207PubMedCrossRef

18.

Diringer MN (2003) Subarachnoid hemorrhage: a multiple-organ system disease. Crit Care Med 31:1884–1885PubMedCrossRef

19.

Solenski NJ, Haley EC Jr, Kassell NF, Kongable G, Germanson T, Truskowski L, Torner JC (1995) Medical complications of aneurysmal subarachnoid hemorrhage: a report of the Multicenter, Cooperative Aneurysm Study. Crit Care Med 23:1007–1017PubMedCrossRef

20.

Gruber A, Reinprecht A, Illievich UM, Fitzgerald R, Dietrich W, Czech T, Richling B (1999) Extracerebral organ dysfunction and neurologic outcome after aneurismal subarachnoid hemorrhage. Crit Care Med 27:505–514PubMedCrossRef

21.

Wartenberg KE, Mayer SA (2006) Medical complications after subarachnoid hemorrhage: new strategies for prevention and management. Curr Opin Crit Care 12:78–84PubMedCrossRef

22.

Wartenberg KE, Schmidt JM, Claassen J, Temes RE, Frontera JA, Ostapkovich N, Parra A, Connolly ES, Mayer SA (2006) Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 34:617–623PubMedCrossRef

23.

Vespa P (2006) The three tenors of subarachnoid hemorrhage: fever, anemia, and hyperglycemia. Crit Care Med 34:897–898PubMedCrossRef

24.

Sminia P, Van Der Zee J, Wondergem J, Haveman J (1994) Effect of hyperthermia on the central nervous system: a review. Int J Hyperthermia 10:1–30PubMed

25.

Corbett D, Thornhill J (2000) Temperature modulation (hypothermic and hyperthermic conditions) and its influence on histological and behavioral outcomes following cerebral ischemia. Brain Pathol 10:145–152PubMedCrossRef

26.

Diringer MN, Reaven NL, Funk SE, Uman GC (2004) Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients. Crit Care Med 32:1489–1495PubMedCrossRef

27.

Kochanek PM, Yonas H (1999) Subarachnoid hemorrhage, systemic immune response syndrome, and MODS: is there cross-talk between the injured brain and the extra-cerebral organ systems? Multiple organ dysfunction syndrome. Crit Care Med 27:454–455PubMedCrossRef

28.

Schaaf I van der, Algra A, Wermer M, Molyneux A, Clarke M, van Gijn J, Rinkel G (2005) Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 19 Oct (4):CD003085

29.

Rl Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274CrossRef

30.

Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817PubMedCrossRef

31.

Stocchetti N, Longhi L, Magnoni S, Roncati Zanier E, Canavesi K (2003) Head injury, subarachnoid hemorrhage and intracranial pressure monitoring in Italy. Acta Neurochir (Wien) 145:761–765CrossRef

Title: Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers
Authors: Guiseppe Citerio
Sergio M. Gaini
Guistino Tomei
Nino Stocchetti
Publication date: 01-09-2007
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 9/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0700-5

2024 ASCO Annual Meeting

Springer Medicine

Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2007

Prolonged use of carbapenems and colistin predisposes to ventilator-associated pneumonia by pandrug-resistant Pseudomonas aeruginosa

Is hyperlipasemia in critically ill patients of clinical importance? An observational CT study

B-type natriuretic peptide as a marker for heart failure in patients with acute stroke

Traumatic pediatric brain injury and intracranial pressure monitoring: does it really improve outcome?

Successful use of extracorporeal membrane oxygenation for severe interstitial lung disease in a child with dermatomyositis

Comparison of lung injury after normal or small volume optimized resuscitation in a model of hemorrhagic shock