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Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage. Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Michael N. Diringer • Thomas P. Bleck • J. Claude Hemphill III • David Menon • Lori Shutter •
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Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference Michael N. Diringer • Thomas P. Bleck • J. Claude Hemphill III • David Menon • Lori Shutter • Paul Vespa • Nicolas Bruder • E. Sander Connolly Jr. • Giuseppe Citerio • Daryl Gress • Daniel Ha¨nggi • Brian L. Hoh • Giuseppe Lanzino • Peter Le Roux • Alejandro Rabinstein • Erich Schmutzhard • Nino Stocchetti • Jose I. Suarez • Miriam Treggiari • Ming-Yuan Tseng • Mervyn D. I. Vergouwen • Stefan Wolf • Gregory Zipfel Neurocrit Care (2011) 15:211–240
Purpose & Process • The purpose of the consensus conference was to develop recommendations for the critical care management of patients following acute aneurysmal SAH • Experts from Europe and North America from the fields of neurosurgery, neurocritical care, neurology, interventional neuroradiology, and neuroanesthesiology were recruited based on their expertise related to each topic
Methods The GRADE System: • The quality of evidence was graded as • High = Further research is very unlikely to change confidence in the estimate of effect • Moderate= Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate • Low = Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. • Very low = Any estimate of effect is very uncertain • Recommendations were classified as strong or weak • According to the balance among benefits, risks, burden, and cost, and according to the quality of evidence
Definitions: Delayed Neurological Deterioration, Delayed Cerebral Ischemia and Vasospasm