Article
Sedation in patients with aneurysmal subarachnoid hemorrhage in Germany: a nation-wide survey
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Authors
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Silvia Hernández-Durán
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
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Vesna Malinova
- Universitätsmedizin Göttingen, Klinik für Neurochirurgie, Göttingen, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Patients with high grade aneurysmal subarachnoid hemorrhage (aSAH) often undergo sedation as part of their treatment. Sedation has been used in the early phase after severe acute brain in order to improve cerebral tolerance to ischemia and to limit supply/demand mismatch in conditions of impaired autoregulation. However, sedation can also reduce cerebral blood flow by lowering mean arterial pressure, thus leading to secondary brain tissue hypoxia/ischemia. To date, there are no prospective trials evaluating sedation in aSAH, and its use has not been standardized.
Methods: We conducted a nation-wide, Internet-based survey of German tertiary centers treating patients with aSAH. Our goal was to assess when sedation is indicated in patients with aSAH, as well as how it is performed.
Results: A total of 35 centers participated in our survey. The most common indications for sedation in aSAH were brain edema/high ICP values (n=31/35, 88.6%), and high-grade aSAH (n=21/35, 60%). The most common ICP cut-off value as indication for sedation was 20 mmHg (n=11/31, 35.5%). Hunt & Hess, WFNS, and Fisher grades have heterogeneous cut-off values as sedation indications. Most centers aim to achieve deep/neuroprotective sedation (n=22/35, 62.8%), and this is assessed by means of RASS (n=26/35, 74.3%) and EEG-monitoring (n=22/35, 62.9%). Propofol, opiates, and benzodiazepines are the preferred medications employed (n=32/35, 91.4%; n=29/35, 82.9%; n=22/35, 62.8%, respectively). Most centers use these drugs in combination (n=31/35, 88.6%), but no trend could be identified. Internal standards of care regarding sedation do not exist in n=18/35, 51.4% of centers. Sedation is continued until normal ICP values are achieved in most centers (n=26/35, 74.3%).
Conclusion: Our results show that German centers included in our survey regularly employ deep sedation in patients with high-grade aSAH and high ICP. While this practice is widespread, no standard of care currently exists, and decision-making remains individual.
