Intensive care management of patients with subarachnoid hemorrhage at san raffaele hospital, milan.

Intensive care of patients with SAH is targeted to recognize and treat the leading cause of death and disability. Hemorrhage, vasospasm, rebleeding, intracranial hypertension can produce ischaemia because the ratio between metabolism (CMR0 (2) ) and cerebral blood flow (CBP) is not coupled. Neuro-ICU bedside monitoring provides information on the intracranial dynamics. Aggressive treatment attempts to avoid ischaemia but needs a clipped or thrombosed (via endovascular approach) aneurysm. The authors propose treatment to improve CBP and reduce CMRO (2) : hypervolaemia, hemodilution, hypertension, ICP reduction, normocapnia, mannitol infusion, normothermia or mild hypothermia and sedation with intravenous anaesthetics. Medical complications such as hypovolemia, infections, pulmonary oedema, gastrointestinal bleeding need to be recognized early and treated.