Management Strategies for Intracranial Pressure Crises in Subarachnoid Hemorrhage

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Neurology

Background:

• Intracranial pressure (ICP) management in traumatic brain injury is well-established.
• Interventions for medically refractory ICP in subarachnoid hemorrhage (SAH) are less understood.
• Optimal strategies for SAH ICP require further investigation.

Purpose of the Study:

• To review the available evidence for managing medically refractory ICP in SAH.
• To evaluate both standard and lesser-known interventions for ICP reduction in SAH.
• To identify gaps in current treatment guidelines for SAH.

Main Methods:

• Systematic literature search of PubMed and EBSCO Host databases.
• Inclusion of studies evaluating standard ICP management (head elevation, hyperventilation, mannitol, hypertonic saline).
• Review of lesser-known interventions including sodium bicarbonate, indomethacin, tromethamine, decompressive craniectomy, decompressive laparotomy, hypothermia, and barbiturate coma, with attention to dosing and administration parameters.

Main Results:

• Standard ICP management strategies are discussed in the context of SAH.
• Lesser-known interventions for refractory ICP in SAH were identified and detailed.
• Significant gaps exist in evidence regarding optimal dosing, timing, and efficacy of these interventions for improving outcomes.

Conclusions:

• Early diagnosis and appropriate management of SAH are vital for reducing adverse outcomes.
• Further research is needed to establish evidence-based guidelines for managing refractory ICP in SAH.
• A comprehensive review of various ICP management strategies provides a foundation for future clinical practice and research.