• Edoardo Picetti, Pierre Bouzat, Mary Kay Bader, Giuseppe Citerio, Raimund Helbok, Janneke Horn, MacdonaldRobert LochRLCommunity Neurosciences Institute, Community Regional Medical Center, Fresno, CA, USA., Victoria McCredie, Geert Meyfroidt, Cássia Righy, Chiara Robba, Deepak Sharma, Wade S Smith, Jose I Suarez, Andrew Udy, Stefan Wolf, and Fabio S Taccone.
• Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
• J Neurosurg Anesthesiol. 2024 Jul 1; 36 (3): 258265258-265.

IntroductionCerebral infarction from delayed cerebral ischemia (DCI) is a leading cause of poor neurological outcome after aneurysmal subarachnoid hemorrhage (aSAH). We performed an international clinical practice survey to identify monitoring and management strategies for cerebral vasospasm associated with DCI in aSAH patients requiring intensive care unit admission.MethodsThe survey questionnaire was available on the European Society of Intensive Care Medicine (May 2021-June 2022) and Neurocritical Care Society (April - June 2022) websites following endorsement by these societies.ResultsThere were 292 respondents from 240 centers in 38 countries. In conscious aSAH patients or those able to tolerate an interruption of sedation, neurological examination was the most frequently used diagnostic modality to detect delayed neurological deficits related to DCI caused by cerebral vasospasm (278 respondents, 95.2%), while in unconscious patients transcranial Doppler/cerebral ultrasound was most frequently used modality (200, 68.5%). Computed tomography angiography was mostly used to confirm the presence of vasospasm as a cause of DCI. Nimodipine was administered for DCI prophylaxis by the majority of the respondents (257, 88%), mostly by an enteral route (206, 71.3%). If there was a significant reduction in arterial blood pressure after nimodipine administration, a vasopressor was added and nimodipine dosage unchanged (131, 45.6%) or reduced (122, 42.5%). Induced hypertension was used by 244 (85%) respondents as first-line management of DCI related to vasospasm; 168 (59.6%) respondents used an intra-arterial procedure as second-line therapy.ConclusionsThis survey demonstrated variability in monitoring and management strategies for DCI related to vasospasm after aSAH. These findings may be helpful in promoting educational programs and future research.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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