Abstract
This article addresses the intensive care unit (ICU) management of patients with aneurysmal
subarachnoid hemorrhage (SAH), with an emphasis on the prevention of cerebral vasospasm
and delayed cerebral ischemia (DCI), which are major contributors to morbidity and
mortality. Interventions addressing various steps in the development of vasospasm
have been attempted, with variable success. Enteral nimodipine remains the only approved
measure to potentially prevent DCI. Since oral and intravenous administrations are
limited by hypotension, direct administration via sustained-release pellets and intraventricular
administration of sustained-release microparticles are being investigated. Studies
of other calcium channel blockers have been disappointing. Efforts to remove blood
from the subarachnoid space via cisternal irrigation, cisternal or ventricular thrombolysis,
and lumbar cerebrospinal fluid drainage have met with limited and variable success,
and they remain an area of active investigation. Several interventions that had early
promise have failed to show benefit when studied in large trials; these include tirilazad,
magnesium, statins, clazosentan, transluminal angioplasty, and hypervolemia.
Keywords
subarachnoid hemorrhage - aneurysm - vasospasm - hypertension - treatment
