Trends in monitoring patients with aneurysmal subarachnoid haemorrhage

J B Springborg, H-J Frederiksen, V Eskesen, N V Olsen

Abstract

After aneurysmal subarachnoid haemorrhage (SAH), the clinical outcome depends upon the primary haemorrhage and a number of secondary insults in the acute post-haemorrhagic period. Some secondary insults are potentially preventable but prevention requires prompt recognition of cerebral or systemic complications. Currently, several neuro-monitoring techniques are available; this review describes the most frequently used techniques and discusses indications for their use, and their value in diagnosis and prognosis. None of the techniques, when considered in isolation, has proved sufficient after SAH. Furthermore, the use of multi-modality monitoring is hampered by a lack of clinical studies that identify combinations of specific techniques in terms of clinical information and reliability. However, ischaemia at the tissue level can be detected by intracerebral microdialysis technique. Used together with the conventional monitoring systems, for example intracranial pressure measurements, transcranial Doppler ultrasound and modern neuro-imaging, direct assessment of biochemical markers by intracerebral microdialysis is promising in the advancement of neurointensive care of patients with SAH. A successfully implemented monitoring system provides answers but it also raises valuable new questions challenging our current understanding of the brain injury after SAH.

Original languageEnglish
JournalBritish Journal of Anaesthesia
Volume94
Issue number3
Pages (from-to)259-70
Number of pages12
ISSN0007-0912
DOIs
Publication statusPublished - Mar 2005
Externally publishedYes

Keywords

  • Cerebrovascular Circulation
  • Critical Care/methods
  • Humans
  • Intracranial Aneurysm/complications
  • Intracranial Pressure
  • Microdialysis/methods
  • Monitoring, Physiologic/methods
  • Oximetry/methods
  • Subarachnoid Hemorrhage/diagnosis
  • Ultrasonography, Doppler, Transcranial

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