Guidelines for the management of aSAH Medical Complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Mehrsefat, M.D. [2]

2012 AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Management of Medical Complications Associated With aSAH: Recommendations

Class I

"1. Heparin-induced thrombocytopenia and deep venous thrombosis are relatively frequent complications after aSAH. Early identification and targeted treatment are recommended, but further research is needed to identify the ideal screening paradigms (Level of Evidence: B)"

Class III (Harm)

"1. Administration of large volumes of hypotonic fluids and intravascular volume contraction is not recommended after aSAH (Level of Evidence: B)"

Class IIa

"1. Monitoring volume status in certain patients with recent aSAH by some combination of central venous pressure, pulmonary wedge pressure, and fluid balance is reasonable, as is treatment of volume contraction with crystalloid or colloid fluids (Level of Evidence: B)"

"2. Aggressive control of fever toatarget of normothermia by use of standard or advanced temperature modulating systems is reasonable in the acute phase of aSAH (Level of Evidence: B)"

"3. The use of fludrocortisone acetate and hypertonic saline solution is reasonable for preventing and correcting hyponatremia (Level of Evidence: B)"

Class IIb

"1. Careful glucose management with strict avoidance of hypoglycemia may be considered as part of the general critical care management of patients with aSAH (Level of Evidence: B)"

"2. The use of packed red blood cell transfusion to treat anemia might be reasonable in patients with aSAH who are at risk of cerebral ischemia. The optimal hemoglobin goal is still to be determined (Level of Evidence: B)"