gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Intensive care management of aneurysmal subarachnoid haemorrhage in Germany – lack of guidelines fosters treatment heterogeneity

Intensivmedizin in aneurysmatischer Subarachnoidalblutung in Deutschland – fehlende Leitlinien fördern Heterogenität

Meeting Abstract

  • presenting/speaker Silvia Hernández-Durán - Universitätsmedizin Göttingen, Klinik für Anästhesiologie und Intensivmedizin, Göttingen, Deutschland
  • Clara Salfelder - Universitätsmedizin Göttingen, Klinik für Anästhesiologie und Intensivmedizin, Göttingen, Deutschland
  • Jörn Schaper - Universitätsmedizin Göttingen, Klinik für Anästhesiologie und Intensivmedizin, Göttingen, Deutschland
  • Onnen Mörer - Universitätsmedizin Göttingen, Klinik für Anästhesiologie und Intensivmedizin, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
  • Christian von der Brelie - Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV022

doi: 10.3205/20dgnc027, urn:nbn:de:0183-20dgnc0273

Veröffentlicht: 26. Juni 2020

© 2020 Hernández-Durán et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Current evidence-based guidelines for the management of aneurysmal subarachnoid hemorrhage (SAH) focus primarily on the timing, modality and technique of aneurysm occlusion, and the prevention and treatment of delayed cerebral ischemia. Significant aspects of management in the intensive care unit (ICU) during the later course of SAH are completely unaddressed, such as ventilation and sedation (VST). SAH patients present unique challenges not accounted for in general VST recommendations and guidelines, which is why we attempted to elucidate VST practices in SAH patients in Germany.

Methods: We conducted a nation-wide survey on VST practices in SAH in Germany. Secondarily, we assessed the existence of and compliance with current guidelines regarding VST practices. The questionnaire was designed in interdisciplinary fashion and distributed online via the kwiksurvey® platform (Bristol, UK).

Results: A total of 50 responses were received, accounting for a response rate of 49%. Twenty-one were university hospitals (UH), 23 high-volume centers (HVC), 6 low-volume centers (LVC). Half of the participating centers do not take into consideration WFNS at presentation to indicate ventilation. While 42% of centers rely on the Horowitz index to indicate ventilation, 62% of them have a cutoff-value of <200, and 38% of <100. Most UH and HVC use propofol for induction of sedation (95%); LVC employ benzodiazepines (100%). Sedation enhancement is done with ketamine in UH (75%) and HVC (60%), whereas LVC use clonidine (100%). These results show great heterogeneity in clinical practice, especially between UH/HVC and LVC. When analyzing existing ICU guidelines, including AWMF, AHA and Neurocritical Care Society, there is a paucity of SAH-tailored recommendations, possibly contributing to the variability reflected in our survey.

Conclusion: Our study clearly demonstrates that attitudes and practices pertaining to VST in SAH are enormously heterogeneous, reflecting the lack of good quality evidence and differing interpretations thereof. While the overall outcome of SAH depends on a multitude of factors, the establishment of evidence-based protocols for the management of these patients in the ICU can potentially solve one part of the puzzle and lead to improved outcomes.