Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome
| العنوان: | Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome |
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| المؤلفون: | Yasuhiro Kuroda, Tomoya Okazaki |
| المصدر: | Journal of Intensive Care Journal of Intensive Care, Vol 6, Iss 1, Pp 1-8 (2018) |
| بيانات النشر: | BioMed Central, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | medicine.medical_specialty, Subarachnoid hemorrhage, Aneurysmal subarachnoid hemorrhage, medicine.medical_treatment, Ischemia, Review, Hypoglycemia, Targeted temperature management, Critical Care and Intensive Care Medicine, Duration of intensive care management, 03 medical and health sciences, 0302 clinical medicine, Cerebral vasospasm, Intensive care, Glycemic management, Fever management, medicine, Sympathetic activity, cardiovascular diseases, Hemodynamic management, Intensive care medicine, Delayed cerebral ischemia, business.industry, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Neurointensive care, 030208 emergency & critical care medicine, Vasospasm, lcsh:RC86-88.9, medicine.disease, Dysnatremia, business, 030217 neurology & neurosurgery, Early brain injury |
| الوصف: | Background Aneurysmal subarachnoid hemorrhage is a life-threatening disease requiring neurocritical care. Delayed cerebral ischemia is a well-known complication that contributes to unfavorable neurological outcomes. Cerebral vasospasm has been thought to be the main cause of delayed cerebral ischemia, and although several studies were able to decrease cerebral vasospasm, none showed improved neurological outcomes. Our target is not cerebral vasospasm but improving neurological outcomes. The purpose of this review is to discuss what intensivists should know and can do to improve clinical outcomes in subarachnoid hemorrhage patients. Main body of the abstract Delayed cerebral ischemia is thought to be due to not only vasospasm but also multifactorial mechanisms. Additionally, the concept of early brain injury, which occurs within the first 72 h after the hemorrhage, has become an important concern. Increasing sympathetic activity after the hemorrhage is associated with cardiopulmonary complications and poor outcomes. Serum lactate measurement may be a valuable marker reflecting the severity of sympathetic activity. The transpulmonary thermodilution method will bring about an advanced understanding of hemodynamic management. Fever is a well-recognized symptom and targeted temperature management is an anticipated intervention. To avoid hyperglycemia and hypoglycemia, performing moderate glucose control and minimizing glucose variability are important concepts in glycemic management, but the optimal target range remains unknown. Dysnatremia seems to be associated with negative outcomes. It is not clear yet that maintaining normonatremia actively improves neurological outcomes. Optimal duration of intensive care management has not been determined. Short conclusion Although we have an advanced understanding of the pathophysiology and clinical characteristics of subarachnoid hemorrhage, there are many controversies in the intensive care unit management of subarachnoid hemorrhage. With an awareness of not only delayed cerebral ischemia but also early brain injury, more attention should be given to various aspects to improve neurological outcomes. |
| اللغة: | English |
| تدمد: | 2052-0492 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0ab7d5a1b335931b0aefeb982ad84162Test http://europepmc.org/articles/PMC5941608Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....0ab7d5a1b335931b0aefeb982ad84162 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20520492 |
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