Subarachnoid Haemorrhage (SAH) is a debilitating condition associated with high mortality and morbidity. The management of SAH is complex following the initial injury and in the post injury phase in the Intensive Care Unit (ICU) where prevention of secondary brain injury is a priority. A significant cause of mortality in the acute phase of injury is the lack of adequate cerebral perfusion leading to cerebral ischemia. One of the main considerations in patient management is maintaining Mean Arterial Pressure (MAP) levels above a certain threshold, thus, avoiding cerebral hypoperfusion. However, due to the absence of a structured protocol to inform patient care and hemodynamic support in ICUs for SAH, managing these patients can result in fluid overload, leading to pulmonary and cerebral oedema. This presents a challenge as it becomes difficult to achieve a euvolemic state, which we aim to address in this proposed study. Managing fluid balance in these patients is also important to avoid derangements of sodium levels. Target sodium levels, and methods to achieve these levels are poorly understood. Furthermore, there are significant variations in the methods used to achieve target blood pressure/MAP in terms of pharmacological agents used.
Through a single-centre observational retrospective study, we aim to observe the current practices of care in patients with vasospasm admitted to the ICU following SAH. We also aim to describe the incidence of neuroendocrine disorders post-SAH in the patient cohort in order to propose early interventional strategies through a review of existing literature. We aim to compile the existing data and summarize methods of optimal fluid management and fluid monitoring (MAP values and sodium levels).We then aim to analyse the trends in management strategies and benchmark against international best practice recommendations, thus providing valuable input in designing a standardized protocol for SAH patients across various ICU settings.
