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The Impact of Sedative Choice in the Management of Aneurysmal Subarachnoid Hemorrhage: A Scoping Review.
Then, James; Tawfik, Samuel; Law, Timothy; Brown, Alastair; Carnegie, Vanessa; Udy, Andrew; Jeffcote, Toby.
Afiliación
  • Then J; Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia. james.then@mh.org.au.
  • Tawfik S; The Victorian Brain and Spine Centre, St. Vincent's Hospital, Melbourne, VIC, Australia.
  • Law T; Department of Intensive Care, St. Vincent's Hospital, Melbourne, VIC, Australia.
  • Brown A; Department of Intensive Care, St. Vincent's Hospital, Melbourne, VIC, Australia.
  • Carnegie V; Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
  • Udy A; Department of Critical Care, University of Melbourne, Melbourne, Australia.
  • Jeffcote T; Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Neurocrit Care ; 2024 Sep 12.
Article en En | MEDLINE | ID: mdl-39266867
ABSTRACT
Aneurysmal subarachnoid hemorrhage (aSAH) is characterized by high mortality and morbidity. This scoping review assesses the current evidence regarding the use of sedatives and analgesics in the acute intensive care unit management of aSAH. We conducted a systematic search of Ovid MEDLINE, Ovid Embase, Ovid EmCare, APA PsycInfo, CINAHL, and the Cochrane Database of Systematic Reviews from inception to June 2023. Studies were included if they enrolled intensive care unit patients aged 18 or older with a significant proportion (> 20%) who had aSAH and evaluated the impact of one or more commonly used analgosedatives on physiological parameters in the management of aSAH. The methodological quality of the studies was assessed using the Methodological Index for Nonrandomized Studies score. Of 2,583 articles, 11 met the inclusion criteria. The median sample size was 47 (interquartile range 10-127), and the median Methodological Index for Nonrandomized Studies score was 9.5 (interquartile range 8-11). The studies' publication years ranged from 1980 to 2023. Dexmedetomidine and ketamine showed potential benefits in reducing the incidence of cortical spreading depolarization and delayed cerebral ischemia. Propofol and opioids appeared safe but lacked robust evidence for efficacy. Benzodiazepines were associated with increased delayed cerebral ischemia-related cerebral infarctions and cortical spreading depolarization events. The evidence available to guide the use of analgosedative medications in aSAH is critically inadequate. Dexmedetomidine and ketamine warrant further exploration in large-scale prospective studies because of their potential benefits. Improved study designs with consistent definitions and a focus on patient-centered outcomes are necessary to inform clinical practice.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos