Recommendations, Considerations and Options–the Dos and Don’ts of Therapeutic and Prophylactic Strategies in Patients with Subarachnoid Hemorrhage

In this commentary article, we discuss five main aspects of therapeutic and prophylactic strategies in the post-interventional care of patients with subarachnoid hemorrhage: (i) Immediate Cerebrospinal Fluid (CSF) diversion, hematoma clearance and antifibrinolytic therapy, (ii) Strict vascular monitoring, vasospasm treatment and prevention of Delayed Cerebral Ischemia (DCI), (iii) Continuous Blood Pressure (BP) monitoring and normalization of BP, (iv) Deep sedation, osmotic therapy and hypothermia for control of Intracranial Pressure (ICP) and (v) Electroencephalography (EEG) monitoring and early and/or prophylactic seizure treatment.Beyond these aspects highlighting the treatment options that are special for the biphasic course of the disease, several other factors contribute to optimal care, which are best applied by standardized treatment bundles.Unless there are individually weighted roles of treatment interventions, of measured parameters and of treated conditions, a comprehensive approach to ensure physiological homeostasis (in terms of circulation and respiration as well as humoral and metabolic balance) remains a basic requirement framing the individualized specific treatment.Continuous monitoring of relevant parameters such as BP, end tidal carbon dioxide, ICP, and EEG if available enables multidisciplinary medical and critical care teams to deliver optimal care.