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Management of non-traumatic subarachnoid haemorrhage in the critically ill 

Management of non-traumatic subarachnoid haemorrhage in the critically ill
Management of non-traumatic subarachnoid haemorrhage in the critically ill

Chethan P. Venkatasubba Rao

and Jose Ignacio Suarez

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date: 05 July 2022

Non-traumatic subarachnoid haemorrhage (ntSAH) is a complex disease affecting multiple systems and the hospital course of affected patients can be variable. ntSAH is associated with high morbidity and mortality, with the causes of early deaths being either rebleeding or hydrocephalus. The risk of rebleeding is reduced by immediate control of arterial blood pressure and early securing of ruptured aneurysms by either endovascular coiling or surgical clipping. Ongoing management focuses on prevention, detection, and management of delayed neurological deficits. Current recommendations include prophylactic use of nimodipine, maintenance of hypertension and euvolaemia or hypervolaemia, and endovascular treatment of vasospasm that fails to respond to medical therapy. Systemic complications following ntSAH include myocardial injury, acute lung injury, venous and pulmonary thromboembolism, fluid and electrolyte abnormalities, and severe sepsis. Each of these complications should be treated on its merits. Due to the complexity of management patients with ntSAH should be treated in a critical care environment by a collaborative team of neurosurgeons, neuroradiologists, neurologists and intensivists.

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