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Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference

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Abstract

Subarachnoid hemorrhage (SAH) is an acute cerebrovascular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs. SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team. A lack of high quality data has led to numerous approaches to management and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of rebleeding, but provide limited discussion of the complex critical care issues involved in the care of SAH patients. The Neurocritical Care Society organized an international, multidisciplinary consensus conference on the critical care management of SAH to address this need. Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise. A jury of four experienced neurointensivists was selected for their experience in clinical investigations and development of practice guidelines. Recommendations were developed based on literature review using the GRADE system, discussion integrating the literature with the collective experience of the participants and critical review by an impartial jury. Recommendations were developed using the GRADE system. Emphasis was placed on the principle that recommendations should be based not only on the quality of the data but also tradeoffs and translation into practice. Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data.

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Acknowledgments

Sponsored by the Neurocritical Care Society with the assistance of an unrestricted grant from Actelion Pharmaceuticals who had no involvement in any aspects of the conference including selection of topics, participants, or development and production of the proceedings.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael N. Diringer.

Additional information

Disclaimer

This statement is provided as an educational service of the Neurocritical Care Society. It is based on an assessment of current literature and the consensus of the opinions of the attendees and jury of the conference. It is not intended to include all possible proper methods of care for SAH patients. Neither is it intended to exclude any reasonable alternative methodologies. The Neurocritical Care Society recognizes that specific patient care decisions are the prerogative of the patient and the physician caring for the patient, based on all of the circumstances involved. No formal practice recommendations should be inferred.

The Organizer, Members of the Jury, and Conference participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage are listed in Appendix.

Appendices

Appendix

Organizer

  • Michael N. Diringer MD, FCCM, Washington University

Members of the Jury

  • Thomas P. Bleck MD FCCM; Rush Medical College

  • J. Claude Hemphill, III, MD, MAS, University of California at San Francisco

  • David Menon, MD, PhD, University of Cambridge

  • Lori Shutter, MD, University of Cincinnati

  • Paul Vespa, MD, University of California at Los Angeles

Conference Participants

  • Nicolas Bruder, MD, Université de la Méditerranée

  • E. Sander Connolly, Jr., MD, Columbia University

  • Giuseppe Citerio, MD, San Gerardo Hospital

  • Daryl Gress, MD, University of Virginia

  • Daniel Hänggi, MD, Heinrich-Heine University

  • Brian L. Hoh, MD, University of Florida

  • Giuseppe Lanzino, MD, Mayo Clinic

  • Peter Le Roux, MD, University of Pennsylvania

  • Alejandro Rabinstein, MD, Mayo Clinic

  • Erich Schmutzhard, MD, University Hospital Innsbruck

  • Nino Stocchetti, MD, Fondazione IRCCS Cà Granda–Ospedale Policlinico, Milan University

  • Jose I. Suarez, MD, Baylor College of Medicine

  • Miriam Treggiari, MD, PhD, University of Washington

  • Ming-Yuan Tseng, MD, Nottingham University Hospitals

  • Mervyn D. I. Vergouwen, MD, PhD, University of Utrecht

  • Stefan Wolf, MD, Freie Universität Berlin

  • Gregory Zipfel, MD, Washington University

Disclosure of Relevant Financial Relationships

Relevant financial relationships are those in which an individual (including the individual’s spouse/partner) in the last 12 months has had a personal financial (any amount) relationship with a commercial interest producing health care goods or services.

Author

Employment

Consultant

Honoraria

Speakers’ bureau

Grant, Research Support

Stock Shareholder

Other

Thomas P. Bleck

Rush Medical College

None

None

None

None

None

None

Nicolas Bruder

Université de la Méditerranée

Actelion Pharmaceuticals

Nycomed

None

None

None

None

E. Sander Connolly Jr.

Columbia University

None

None

None

None

None

None

Giuseppe Citerio

San Gerardo Hospital

None

None

None

None

None

None

Daryl Gress

University of Virginia

None

None

None

None

None

None

Daniel Hanggi

Heinrich-Heine University

None

None

None

None

None

None

J. Claude Hemphill, III

University of California at San Francisco

Ornim

None

None

None

Ornim

None

Brian L. Hoh

University of Florida

None

Codman Neurovascular

None

None

None

None

Giuseppe Lanzino

Mayo Clinic

None

None

None

None

None

Educational grant EV3

David Menon

University of Cambridge

None

None

None

None

None

None

Peter Le Roux

University of Pennsylvania

Codman, Cerebrotech

None

None

Intergra, Neurologica, CMA

None

Edge Therapeutics

Alejandro Rabinstein

Mayo Clinic

None

None

None

CardioNet Inc.

None

None

Erich Schmutzhard

University Hospital Innsbruck

None

Actelion Pharmaceuticals

None

Actelion Pharmaceuticals

None

None

Lori Shutter

University of Cincinnati

None

None

None

None

None

None

Nino Stocchetti

Milan University

None

None

None

None

None

None

Jose I Suarez

Baylor College of Medicine

None

Actelion Pharmaceuticals

None

None

None

None

Miriam Treggiari

University of Washington

None

None

None

None

None

None

MY Tseng

Nottingham University Hospitals

None

None

None

None

None

None

Mervyn D. I. Vergouwen

University of Utrecht

None

None

None

None

None

None

Paul Vespa

University of California at Los Angeles

Edge Pharma

None

None

None

None

None

Stephan Wolf

Freie Universität Berlin

None

Pulsion Medical Systems AG

None

None

None

None

Gregory Zipfel

Washington University

None

None

None

None

None

None

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Diringer, M.N., Bleck, T.P., Claude Hemphill, J. et al. Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care 15, 211–240 (2011). https://doi.org/10.1007/s12028-011-9605-9

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