Unterschiede im intensivmedizinischen Management bei akuter aneurysmatischer Subarachnoidalblutung: eine Umfragestudie

Abstract

Objective: The aim of this study is to provide an overview of the management of acute aneurysmal subarachnoid haemorrhage (SAH) and more specifically of the management of ventilation and sedation therapy (VST) in the intensive care unit. Current guidelines for the treatment of SAH focus primarily on aneurysm occlusion and the prevention and treatment of delayed cerebral ischaemia (DCI). VST remains predominantly unconsidered. Methods: We conducted a nationwide survey on intensive care management of SAH in Germany. Another focus was to place the survey results in the context of existing guidelines. The questionnaire was designed in an interdisciplinary manner and distributed online via the kwiksurvey® platform (Bristol, UK). Results: A total of 50 centres participated, representing a response rate of 49%. 21 of these were university hospitals (UH), 23 high volume centres (HVC), 6 low volume centres (LVC). Half of the participating centres do not consider the WFNS scale for indication of ventilation. 42 % of the centres use the P/F ratio to indicate ventilation. 62 % of them report a cut-off value of <200 and 38 % of <100. While most UH and HVC use propofol for the first stage of sedation (95 %), LVC use benzodiazepines (100 %). Ketamine was used to deepen sedation in UH (75%) and HVC (60%), while clonidine was predominantly used in LVC (100%). Conclusions: Our study clearly shows that intensive care management of SAH is very heterogeneous, which can be attributed to the general lack of high-quality evidence-based data and their varying interpretation.