Intensive Care for Patients with Subarachnoid Haemorrhage

Abstract

Italian

The intensive care treatment in patients with subarachnoid haemorrhage (SAH) is aimed at maintenance of adequate cerebral perfusion and oxygenation. SAH is charged in 40% of cases with at least one life-threatening event and 20 to 30% of deaths are related to extracerebral complications. So the main task in Neurointensive Care is to keep the physiological parameters under control. That is why we need accurate monitoring. Currently used systemic and cerebral monitoring is thus presented. Even basic cardiovascular monitoring (ECG, blood pressure, pulse oxymetry, central venous pressure, urine output) need a great workload in managing the quality of signals and raw data. SAH is often associated with cardiovascular impairment; haemodynamic monitoring is then necessary to graduate hynotropic (stroke volume, cardiac index, systemic and pulmonary resistances) and volemic support (central venous pressure, wedge pressure): a Swan-Ganz catheter is then indicated. Then ventilation is considered: non only a “cerebral” oriented ventilation but a strategy aimed at pulmonary protection too. The ultimate result of ventilation is still adequate oxygenation and acid-base balance that are to be verified. Cerebral monitoring is then resumed starting from cerebral perfusion pressure. The O₂ delivery is monitored by a global estimation like jugular venous oxygen saturation, that has a low sensitivity in SAH patients, and by tissue O₂ tension which measure O₂ delivered near the injured area.

Lastly, Transcranial Doppler Monitoring is presented with its limits and indications. Three clinical examples are presented on a multimodal approach in TCD, PtO₂ and cerebral perfusion pressure monitoring.

Keywords

subarachnoid haemorrage critical care monitoring

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