Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers

Guiseppe Citerio, Sergio M. Gaini, Guistino Tomei, Nino Stocchetti

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objective: To collect information on clinical practice and current management strategies in 22 Italian neurosurgical hospitals for patients with aneurysmal subarachnoid hemorrhage. Design and setting: Observational 6-month study for prospective data collection. Patients: 350 cases of aneurysmal subarachnoid hemorrhage. Measurements and results: Each center enrolled from 4-36 patients. Neurological deterioration (24%) was more frequent in patients with higher Fisher classification, and with pretreatment rebleeding and it was associated with an unfavorable outcome (46%, 36/78, vs. 33%, 83/251). Aneurysms were mainly secured by clipping (55%, 191/350). An endovascular approach was utilized in 35% (121/350). The more frequent medical complications were fever, recorded in one-half of cases, pneumonia (18%), sodium disturbances (hyponatremia 22%, hypernatremia 17%), cardiopulmonary events as neurogenic pulmonary edema (4%) and myocardial ischemia (5%). Intracranial hypertension was experienced in one-third of the patients, followed by hydrocephalus (29%) and vasospasm (30%). Cerebral ischemia was found in an about one-quarter of the cohort. To identify the independent predictors of outcome we developed a model in which the dichotomized Glasgow Outcome Scale was tested as function of extracranial and intracranial complications. Only high intracranial pressure and deterioration in neurological status were independent factors related to unfavorable outcome. Conclusions: Our data confirm that in every step of care there is extreme heterogeneity among centers. These patients are complex, with comorbidities, immediate risk of rebleeding, and delayed risk of intracranial and medical complications. Following SAH early treatment and careful intensive care management requires the careful coordination of the various clinical specialties.

Original languageEnglish
Pages (from-to)1580-1586
Number of pages7
JournalIntensive Care Medicine
Volume33
Issue number9
DOIs
Publication statusPublished - Sep 2007

Fingerprint

Subarachnoid Hemorrhage
Hypernatremia
Glasgow Outcome Scale
Intracranial Hypertension
Hyponatremia
Practice Management
Intracranial Pressure
Pulmonary Edema
Critical Care
Hydrocephalus
Brain Ischemia
Myocardial Ischemia
Aneurysm
Comorbidity
Pneumonia
Fever
Sodium
Prospective Studies

Keywords

  • Aneurysm
  • Clipping
  • Coiling
  • Outcome
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers. / Citerio, Guiseppe; Gaini, Sergio M.; Tomei, Guistino; Stocchetti, Nino.

In: Intensive Care Medicine, Vol. 33, No. 9, 09.2007, p. 1580-1586.

Research output: Contribution to journalArticle

Citerio, Guiseppe ; Gaini, Sergio M. ; Tomei, Guistino ; Stocchetti, Nino. / Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers. In: Intensive Care Medicine. 2007 ; Vol. 33, No. 9. pp. 1580-1586.
@article{507db43ca85b47f0909204e8ba24cf3e,
title = "Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers",
abstract = "Objective: To collect information on clinical practice and current management strategies in 22 Italian neurosurgical hospitals for patients with aneurysmal subarachnoid hemorrhage. Design and setting: Observational 6-month study for prospective data collection. Patients: 350 cases of aneurysmal subarachnoid hemorrhage. Measurements and results: Each center enrolled from 4-36 patients. Neurological deterioration (24{\%}) was more frequent in patients with higher Fisher classification, and with pretreatment rebleeding and it was associated with an unfavorable outcome (46{\%}, 36/78, vs. 33{\%}, 83/251). Aneurysms were mainly secured by clipping (55{\%}, 191/350). An endovascular approach was utilized in 35{\%} (121/350). The more frequent medical complications were fever, recorded in one-half of cases, pneumonia (18{\%}), sodium disturbances (hyponatremia 22{\%}, hypernatremia 17{\%}), cardiopulmonary events as neurogenic pulmonary edema (4{\%}) and myocardial ischemia (5{\%}). Intracranial hypertension was experienced in one-third of the patients, followed by hydrocephalus (29{\%}) and vasospasm (30{\%}). Cerebral ischemia was found in an about one-quarter of the cohort. To identify the independent predictors of outcome we developed a model in which the dichotomized Glasgow Outcome Scale was tested as function of extracranial and intracranial complications. Only high intracranial pressure and deterioration in neurological status were independent factors related to unfavorable outcome. Conclusions: Our data confirm that in every step of care there is extreme heterogeneity among centers. These patients are complex, with comorbidities, immediate risk of rebleeding, and delayed risk of intracranial and medical complications. Following SAH early treatment and careful intensive care management requires the careful coordination of the various clinical specialties.",
keywords = "Aneurysm, Clipping, Coiling, Outcome, Subarachnoid hemorrhage",
author = "Guiseppe Citerio and Gaini, {Sergio M.} and Guistino Tomei and Nino Stocchetti",
year = "2007",
month = "9",
doi = "10.1007/s00134-007-0700-5",
language = "English",
volume = "33",
pages = "1580--1586",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "9",

}

TY - JOUR

T1 - Management of 350 aneurysmal subarachnoid hemorrhages in 22 Italian neurosurgical centers

AU - Citerio, Guiseppe

AU - Gaini, Sergio M.

AU - Tomei, Guistino

AU - Stocchetti, Nino

PY - 2007/9

Y1 - 2007/9

N2 - Objective: To collect information on clinical practice and current management strategies in 22 Italian neurosurgical hospitals for patients with aneurysmal subarachnoid hemorrhage. Design and setting: Observational 6-month study for prospective data collection. Patients: 350 cases of aneurysmal subarachnoid hemorrhage. Measurements and results: Each center enrolled from 4-36 patients. Neurological deterioration (24%) was more frequent in patients with higher Fisher classification, and with pretreatment rebleeding and it was associated with an unfavorable outcome (46%, 36/78, vs. 33%, 83/251). Aneurysms were mainly secured by clipping (55%, 191/350). An endovascular approach was utilized in 35% (121/350). The more frequent medical complications were fever, recorded in one-half of cases, pneumonia (18%), sodium disturbances (hyponatremia 22%, hypernatremia 17%), cardiopulmonary events as neurogenic pulmonary edema (4%) and myocardial ischemia (5%). Intracranial hypertension was experienced in one-third of the patients, followed by hydrocephalus (29%) and vasospasm (30%). Cerebral ischemia was found in an about one-quarter of the cohort. To identify the independent predictors of outcome we developed a model in which the dichotomized Glasgow Outcome Scale was tested as function of extracranial and intracranial complications. Only high intracranial pressure and deterioration in neurological status were independent factors related to unfavorable outcome. Conclusions: Our data confirm that in every step of care there is extreme heterogeneity among centers. These patients are complex, with comorbidities, immediate risk of rebleeding, and delayed risk of intracranial and medical complications. Following SAH early treatment and careful intensive care management requires the careful coordination of the various clinical specialties.

AB - Objective: To collect information on clinical practice and current management strategies in 22 Italian neurosurgical hospitals for patients with aneurysmal subarachnoid hemorrhage. Design and setting: Observational 6-month study for prospective data collection. Patients: 350 cases of aneurysmal subarachnoid hemorrhage. Measurements and results: Each center enrolled from 4-36 patients. Neurological deterioration (24%) was more frequent in patients with higher Fisher classification, and with pretreatment rebleeding and it was associated with an unfavorable outcome (46%, 36/78, vs. 33%, 83/251). Aneurysms were mainly secured by clipping (55%, 191/350). An endovascular approach was utilized in 35% (121/350). The more frequent medical complications were fever, recorded in one-half of cases, pneumonia (18%), sodium disturbances (hyponatremia 22%, hypernatremia 17%), cardiopulmonary events as neurogenic pulmonary edema (4%) and myocardial ischemia (5%). Intracranial hypertension was experienced in one-third of the patients, followed by hydrocephalus (29%) and vasospasm (30%). Cerebral ischemia was found in an about one-quarter of the cohort. To identify the independent predictors of outcome we developed a model in which the dichotomized Glasgow Outcome Scale was tested as function of extracranial and intracranial complications. Only high intracranial pressure and deterioration in neurological status were independent factors related to unfavorable outcome. Conclusions: Our data confirm that in every step of care there is extreme heterogeneity among centers. These patients are complex, with comorbidities, immediate risk of rebleeding, and delayed risk of intracranial and medical complications. Following SAH early treatment and careful intensive care management requires the careful coordination of the various clinical specialties.

KW - Aneurysm

KW - Clipping

KW - Coiling

KW - Outcome

KW - Subarachnoid hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=34548155013&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548155013&partnerID=8YFLogxK

U2 - 10.1007/s00134-007-0700-5

DO - 10.1007/s00134-007-0700-5

M3 - Article

C2 - 17541545

AN - SCOPUS:34548155013

VL - 33

SP - 1580

EP - 1586

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 9

ER -