Preventing delayed cerebral ischemia in secured aneurysmal subarachnoid haemorrhage, in an era after the fall of triple-H therapy: a narrative overview for nurses
References
- Ahn, J, Mastorakos, P, Sokolowski, JD, Kellogg, R, Park, MS, and Chen, CJ (2022) ‘Effects of hyperoxemia on aneurysmal subarachnoid hemorrhage outcomes: a systematic review and meta-analysis’, Neurosurgical Focus, Vol. 52, No 3:
https://doi.org/10.3171/2021.12.FOCUS21660 - Anetsberger, A, Gempt, J, Blobner, M, Ringel, F, Bogdanski, R, Heim, M, Schneider, G, Meyer, B, Schmid, S, Ryang, Wostrack, Schneider, J, Martin, J, Ehrhardt, M and Jungwirth, B (2020) ‘Impact of Goal-Directed Therapy on Delayed Ischemia After Aneurysmal Subarachnoid Hemorrhage: Randomised Controlled Trial’ Stroke, Vol. 51, No 8: pp. 2287–2296,
https://doi.org/10.1161/strokeaha.120.029279 - Balasekaran, N, Soelar, S A, Anbarasen, L, Cham, CY, Rajandram, R, and Sia, SF (2021) ‘Vasospasm and delayed cerebral ischaemia in patients with spontaneous subarachnoid haemorrhage (aneurysmal and pretruncal non-aneurysmal): a centre’s perspective’ The Medical Journal of Malaysia, Vol. 76, No 1: pp. 17–23.
- Burrell, C, Avalon, N E, Siegel, J, Pizzi, M, Dutta, T, Charlesworth, MC and Freeman, WD (2016) ‘Precision medicine of aneurysmal subarachnoid hemorrhage, vasospasm and delayed cerebral ischemia’ In Expert Review of Neurotherapeutics, Vol. 16, pp. 1251–1262.
- De Winkel, J, van der Jagt, M, Lingsma, HF, Roozenbeek, B, Calvillo, E, Chou, SHY, Dziedzic, PH, Etminan, N, Huang, J, Ko, NU, Loch MacDonald, R, Martin, R L, Potu, NR, Venkatasubba Rao, CP, Vergouwen, MDI and Suarez, J I (2021) ‘International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage’ Journal of clinical medicine, Vol.10, No 4.
https://doi.org/10.3390/jcm10040762 - Djilvesi, D, Horvat, I, Jelaca, B, Golubovic, J, Pajicic, F and Vulekovic, P (2020) ‘Comparison of radiological versus clinical cerebral vasospasm after aneurysmal subarachnoid hemorrhage: is vasospasm always present?’ Neurological Research, Vol. 42, No.12: pp. 1027–1033.
https://doi.org/10.1080/01616412.2020.1796404 - Fukuda, S, Koga, Y, Suehiro, E, Kaneda, K, Tsuruta, R, Fujita, M, Oda, Y, Ishihara, H and Suzuki, M (2021) ‘Hyperoxemia during the hyperacute phase of aneurysmal subarachnoid hemorrhage is associated with delayed cerebral ischemia and poor outcome: A retrospective observational study’ Journal of Neurosurgery, Vol.134, No. 1: pp. 25–32.
https://doi.org/10.3171/2019.9.JNS19781 - Göttsche, J, Schweingruber, N, Groth, JC, Gerloff, C, Westphal, M and Czorlich, P (2021) ‘Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage’ Frontiers in Neurology, Vol. 12, 748413.
https://doi.org/10.3389/fneur.2021.748413 - Hickey, JV (2014) The clinical practice of neurological and neurosurgical nursing. Philadelphia: Lippincott Williams & Wilkins.
- Hoff, RG, Rinkel, GJE, Verweij, BH, Algra, A and Kalkman, CJ (2008) ‘Nurses’ prediction of volume status after aneurysmal subarachnoid haemorrhage: a prospective cohort study’ Critical care, Vol. 12, No. 6.
https://doi.org/10.1186/cc7142 . - Hofmann, BB, Donaldson, DM, Fischer, I, Karadag, C, Neyazi, M, Piedade, GS, Abusabha, Y, Muhammad, S, Rubbert, C, Hänggi, D and Beseoglu, K (2023) ‘Blood Pressure Affects the Early CT Perfusion Imaging in Patients with aSAH Reflecting Early Disturbed Autoregulation’ Neurocritical Care, Vol. 39, No. 1: pp.125–134.
https://doi.org/10.1007/s12028-023-01683-8 - Hoh, BL, Ko, NU, Amin-Hanjani, S, Hsiang-Yi Chou, S, Cruz-Flores, S, Dangayach, NS, Derdeyn, CP, Du, R, Hänggi, D, Hetts, SW, Ifejika, NL, Johnson, R, Keigher, K M, Leslie-Mazwi, TM, Lucke-Wold, B, Rabinstein, AA, Robicsek, SA, Stapleton, CJ, Suarez, JI and Welch, BG (2023) ‘2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association’ Stroke, Vol. 54, No.7: pp. E314–E370.
https://doi.org/10.1161/STR.0000000000000436 - Isse, FA, Abdallah, YEH and Mahmoud, SH (2020) ‘The Impact of Nimodipine Administration through Feeding Tube on Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage’ Journal of Pharmacy & Pharmaceutical Sciences, Vol. 23, No. 1: pp. 100–108.
https://doi.org/10.18433/jpps30960 - Joffe, AM, Khandelwal, N, Hallman, MR and Treggiari, MM (2015). ‘Assessment of Circulating Blood Volume with Fluid Administration Targeting Euvolemia or Hypervolemia’ Neurocritical Care, Vol. 22, No. 1: pp. 82–88.
https://doi.org/10.1007/s12028-014-9993-8 - Kasuya, H, Onda, H, Yoneyama, T, Sasaki, T and Hori, T (2003) ‘Bedside monitoring of circulating blood volume after subarachnoid hemorrhage’ Stroke, Vol. 34, No.4: pp. 956–960.
https://doi.org/10.1161/01.STR.0000064321.10700.63 - Lavinio, A, Andrzejowski, J, Antonopoulou, I, Coles, J, Geoghegan, P, Gibson, K, Gudibande, S, Lopez-Soto, C, Mullhi, R, Nair, P, Pauliah, VP, Quinn, A, Rasulo, F, Ratcliffe, A, Reddy, U, Rhodes, J, Robba, C, Wiles, M and Williams, A (2023) ‘Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: updated consensus guideline recommendations by the Neuroprotective Therapy Consensus Review (NTCR) group’ British Journal of Anaesthesia, Vol. 131, No. 2: pp. 294–301.
https://doi.org/10.1016/j.bja.2023.04.030 - Lennihan, L, Mayer, SA, Fink, ME, Klebanoff, LM, Raps, EC, Beckford, A, Solomon, R A, Paik, MC, Zhang, H and Wu, YC (2000) ‘Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: A randomised controlled trial’ Stroke, Vol.31, No.2: pp. 383–391.
https://doi.org/10.1161/01.STR.31.2.383 - Liu, Y, Li, Y, Han, B, Mei, L, Zhang, P, Zhang, J, Xu, M, Gao, M and Feng, G (2024) ‘Targeted Temperature Management for Poor Grade Aneurysmal Subarachnoid Hemorrhage: A Pilot Study’ World Neurosurgery, Vol.183, pp. e846–e859.
https://doi.org/10.1016/j.wneu.2024.01.041 - Loan, JJM, Wiggins, AN and Brennan, PM (2018) ‘Medically induced hypertension, hypervolaemia and haemodilution for the treatment and prophylaxis of vasospasm following aneurysmal subarachnoid haemorrhage: systematic review’ British Journal of Neurosurgery, Vol. 32, No. 2: pp. 157–164.
https://doi.org/10.1080/02688697.2018.1426720 - Mahmoud, SH, Hefny, FR, Panos, NG, Delucilla, L, Ngan, Z, Perreault, MM, Hamilton, LA, Rowe, AS, Buschur, PL, Owusu-Guha, J, Almohaish, S, Sandler, M, Brophy, GM, Armahizer, MJ, Barra, ME, Cook, AM, Barthol, CA, Hintze, TD, Cantin, A and Keegan, SP (2023) ‘Comparison of nimodipine formulations and administration techniques via enteral feeding tubes in patients with aneurysmal subarachnoid hemorrhage: A multi-center retrospective cohort study’ Pharmacotherapy, Vol. 43, No. 4: pp. 279–290.
https://doi.org/10.1002/phar.2791 - Moser, MM, Rössler, K, Hirschmann, D, Gramss, L, Tahir, A, Plöchl, W, Herta, J, Reinprecht, A, Zeitlinger, M and Hosmann, A (2025) ‘Cerebral Ischemia Protection After Aneurysmal Subarachnoid Hemorrhage: CSF Nimodipine Levels After Intravenous Versus Oral Nimodipine Administration’ Clinical Pharmacology and Therapeutics, Vol. 117, No. 2: pp. 589–597.
https://doi.org/10.1002/cpt.3499 - Murphy, A, Oliveira Manoel, A, Macdonald, R, Baker, A, Lee, TY, Marotta, T, Montanera, W, Aviv, R, Bharatha, A, de Oliveira Manoel, AL and Macdonald, RL (2017) ‘Changes in Cerebral Perfusion with Induced Hypertension in Aneurysmal Subarachnoid Hemorrhage: A Pilot and Feasibility Study’ Neurocritical Care, Vol. 27, No. 1: pp. 3–10.
https://doi.org/10.1007/s12028-017-0379-6 - Narayanan, BJ, Rao, SV and Kandasamy, S (2025) ‘Peripheral Perfusion Index for Prediction of Fluid Responsiveness in Spontaneously Breathing Critically Ill Patients: A Prospective Observational Study’ Indian Journal of Critical Care Medicine, Vol. 29, No. 2: pp. 151–154.
https://doi.org/10.5005/jp-journals-10071-24898 - National Institute for Health and Care Excellence (NICE) (2022) ‘Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management. Managing a confirmed aneurysmal subarachnoid haemorrhage’
https://www.tripdatabase.com/Searchresult?criteria=subarachnoid%20haemorrhage%20caused%20by%20a%20ruptured%20aneurysm:%20diagnosis%20AND%20management&search_type=standard - Picetti, E, Bouzat, P, Bader, MK, Citerio, G, Helbok, R, Horn, J, Macdonald, RL, McCredie, V, Meyfroidt, G, Righy, C, Robba, C, Sharma, D, Smith, WS, Suarez, J I, Udy, A, Wolf, S and Taccone, FS (2024) ‘ A Survey on Monitoring and Management of Cerebral Vasospasm and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: The Mantra Study’ Journal of Neurosurgical Anesthesiology, Vol. 36, No. 3: pp. 258–265.
https://doi.org/10.1097/ana.0000000000000923 - Pickard, JD, Murray, GD, Illingworth, R, Shaw, MDM, Teasdale, GM, Foy, PM, Humphrey, PRD, Lang, DA, Nelson, R, Richards, P, Sinar, J, Bailey, S and Skene, A (1989) ‘Effect Of Oral Nimodipine On Cerebral Infarction And Outcome After Subarachnoid Haemorrhage: British Aneurysm Nimodipine Trial’ BMJ: British Medical Journal, Vol. 298, pp. 636–642.
- Rass, V, Kindl, P, Lindner, A, Kofler, M, Altmann, K, Putnina, L, Ianosi, BA, Schiefecker, A.J, Beer, R, Pfausler, B and Helbok, R (2023) ‘Blood Pressure Changes in Association with Nimodipine Therapy in Patients with Spontaneous Subarachnoid Hemorrhage’ Neurocritical Care, Vol. 39, No. 1: pp. 104–115.
https://doi.org/10.1007/s12028-023-01760-y - Reynolds, R.A, Amin, SN, Jonathan, SV, Tang, AR, Lan, M, Wang, C, Bastarache, JA, Ware, LB and Thompson, RC (2021) ‘Hyperoxemia and Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage’ Neurocritical Care, Vol. 35, No. 1: pp. 30–38.
https://doi.org/10.1007/s12028-020-01136-6 - Robba, C, Battaglini, D, Cinotti, R, Asehnoune, K, Stevens, R, Taccone, FS, Badenes, R and Pelosi, P (2023) ‘Individualized Thresholds of Hypoxemia and Hyperoxemia and their Effect on Outcome in Acute Brain Injured Patients: A Secondary Analysis of the ENIO Study’ Neurocritical Care, Vol. 40, No. 2: pp. 515–528.
https://doi.org/10.1007/s12028-023-01761-x - Sandow, N, Diesing, D, Sarrafzadeh, A, Vajkoczy, P and Wolf, S (2016) ‘Nimodipine Dose Reductions in the Treatment of Patients with Aneurysmal Subarachnoid Hemorrhage’ Neurocritical Care, Vol. 25, No.1: pp. 29–39.
https://doi.org/10.1007/s12028-015-0230-x - Schmidt, T P, Weiss, M, Hoellig, A, Nikoubashman, O, Schulze-Steinen, H, Albanna, W, Clusmann, H, Schubert, G A and Veldeman, M (2022) ‘Revisiting the Timeline of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: Toward a Temporal Risk Profile’ Neurocritical Care, Vo. 37, No.3: pp. 735–743.
https://doi.org/10.1007/s12028-022-01545-9 - Silverman, A, Kodali, S, Strander, S, Gilmore, EJ, Kimmel, A, Wang, A and Cord, B (2019) ‘Deviation From Personalised Blood Pressure Targets Is Associated With Worse Outcome After Subarachnoid Hemorrhage’ Stroke, Vol. 50, No. 10: pp. 2729–2737.
https://doi.org/10.1161/STROKEAHA.119.026282 - Sivakumar, S and Lazaridis, C (2020) ‘Bioreactance-Based Noninvasive Fluid Responsiveness and Cardiac Output Monitoring: A Pilot Study in Patients with Aneurysmal Subarachnoid Hemorrhage and Literature Review’ Critical Care Research and Practice, eCollection 2020.
https://doi.org/10.1155/2020/2748181 - Solou, M, Ydreos, I, Papadopoulos, EK, Demetriades, AK. and Boviatsis, EJ (2023) ‘Management of neurological complications related to aneurysmal subarachnoid hemorrhage: A comparison of the bedside therapeutic algorithms’ The Surgeon, Vol. 21, No.6: pp. e328–e345.
https://doi.org/10.1016/j.surge.2023.06.006 - Tagami, T, Kuwamoto, K, Watanabe, A, Unemoto, K, Yokobori, S, Matsumoto, G, Igarashi, Y and Yokota, H (2014) ‘Effect of triple-h prophylaxis on global end-diastolic volume and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage’ Neurocritical Care, Vol. 21, No. 3: pp. 462–469.
https://doi.org/10.1007/s12028-014-9973-z - Treggiari, MM, Rabinstein, AA, Busl, KM, Caylor, MM, Citerio, G, Deem, S, Diringer, M, Fox, E, Livesay, S, Sheth, KN, Suarez, JI and Tjoumakaris, S (2023) ‘Guidelines for the Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage’ Neurocritical Care, Vol. 39, No.1: pp. 1–28.
https://doi.org/10.1007/s12028-023-01713-5 - Udy, AA, Schweikert, S, Anstey, J, Anstey, M, Cohen, J, Flower, O, Saxby, E, Van der Poll, A and Delaney, A (2017) ‘Critical care management of aneurysmal subarachnoid haemorrhage in Australia and New Zealand: What are we doing, and where to from here?’ Critical Care and Resuscitation, Vol. 19, No. 2: pp.103–109.
https://doi.org/10.1016/S1441-2772(23)00780-9 - Van Genderen, ME, Engels, N, Van der Valk, RJ, Lima, A, Klijn, E, Bakker, J and Van Bommel, J (2015) ‘Early peripheral perfusion-guided fluid therapy in patients with septic shock’ American Journal of Respiratory and Critical Care Medicine, Vol. 191, No. 4: pp. 477–480.
https://doi.org/10.1164/rccm.201408-1575LE - Van Genderen, ME, Lima, A, Bezemer, R, Ince, C, Bakker, J, Van Bommel, J and Bartels, SA (2013) ‘Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers’. Anesthesia and Analgesia, Vol. 116, No. 2: pp. 351–356.
https://doi.org/10.1213/ANE.0b013e318274e151 - Vergouw, LJ.M., Egal, M, Bergmans, B, Bakker, J, van der Jagt, M, Dippel, DWJ, Lingsma, HF, Vergouwen, MDI, Willems, PWA and Oldenbeuving, AW (2020) ‘High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction’ Journal of Intensive Care Medicine, Vol. 35, No. 2: pp. 161–169.
https://doi.org/10.1177/0885066617732747 - Vergouwen, MD, Vermeulen, M, van Gijn, J, Rinkel, GJ, Wijdicks, EF, Muizelaar, J P, Mendelow, AD, Juvela, S, Yonas, H, Terbrugge, KG, Macdonald, RL, Diringer, MN, Broderick, JP, Dreier, JP and Roos, YB (2010) ‘Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multi-disciplinary research group’ Stroke, Vol. 41, No.10: pp. 2391–2395.
https://doi.org/10.1161/strokeaha.110.589275 - Yokoyama, S, Minamino, T, Hifumi, T, Kawakita, K, Kuroda, Y and Tamiya, T (2019) ‘Early hyperoxia in the intensive care unit is significantly associated with unfavourable neurological outcomes in patients with mild-to-moderate aneurysmal subarachnoid hemorrhage’ Shock, Vol. 51, No. 5: pp. 593–598.
https://doi.org/10.1097/SHK.0000000000001221
Language: English
Page range: 44 - 58
Published on: May 18, 2026
Published by: Australasian Neuroscience Nurses Association
In partnership with: Paradigm Publishing Services
Publication frequency: 2 issues per year
Keywords:
Related subjects:
© 2026 Elizabeth Viji Abraham, published by Australasian Neuroscience Nurses Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.