Abstract
Although hyperdynamic therapy is an accepted method of treatment of patients with symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage, it remains unproven in large scale trials and controlled studies. Furthermore, methods of hyperdynamic therapy and specific endpoints vary widely. A systematic review of clinical trials of the various techniques of hyperdynamic therapy and their effects on cerebral blood flow found only 11 studies suitable for analysis. Although controlled trials are lacking, there is some evidence to suggest that hypertension is the most promising component of hyperdynamic therapy. These findings support a future randomized trial of induced hypertension in patients with symptomatic cerebral vasospasm.
Highlights
Hyperdynamic therapy is an accepted method of treatment of patients with symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage, it remains unproven in large scale trials and controlled studies
In a previous issue of Critical Care, Dankbaar and colleagues [1] presented a systematic review of clinical studies of hyperdynamic therapy and its components on cerebral blood flow (CBF)
Symptomatic cerebral vasospasm is defined as cerebral ischemia attributable to narrowing of intracranial arteries and loss of cerebral autoregulation, and afflicts some 20 to 25% of patients after rupture of an intracranial aneurysm [2,3]
Summary
Hyperdynamic therapy is an accepted method of treatment of patients with symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage, it remains unproven in large scale trials and controlled studies. In a previous issue of Critical Care, Dankbaar and colleagues [1] presented a systematic review of clinical studies of hyperdynamic therapy and its components on cerebral blood flow (CBF). The cornerstone of medical therapy for cerebral vasospasm is so-called hyperdynamic therapy.
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