Table 1 : Reference guide: Specific recommendations for the management of vasospasm in patients with SAH.
| Condition | Mangement |
| No vasospasm | |
| Clinically intact | -- |
| Normal TCD | -- |
| Post clipping/coiling | Normotension SBP>120 mmHg or 30% above baseline normal systemic venous pressure (8-14 cm H20) Fluid: normal saline (NS) 200 ml/hr Calcium channel blockers (CCB): nimodipine 60 mg po q 4hrs or 30 g/kg/h |
| Untreated aneurysma | Normotension SBP 120-140 mmHg |
| Systemic venous pressure 6-10 cm H20 | |
| CCB as above | |
| Subclinical vasospasm | |
| No DIND | -- |
| High TCDs (>200 cm/sec) | -- |
| Radio graphic evidence | -- |
| Post clipping/coiling | Tripple-H Therapy Maintain SBP 160-180 mmHg PCWP 12-40 mmHg Cl 5 L/min/m3 Fluid: NS + colloid 200-250 ml/h Hct 30-35% CCB |
| Untreated aneurysma | Maintain SBP 120-140 mmHg |
| PCWP 10-14 mmHg | |
| Cl 3,5-4,5 L/min/m3 | |
| CCB | |
| Clinical vasospasm | |
| DIND | -- |
| High TCDs | -- |
| Radio graphic vasospasm | -- |
| Post clipping/coiling | Triple –H therapy Increase SBP to reverse DIND PCWP 12-16 mmHg Refractory cases: consider angionplasty with or without intrarterial agents CCB |
| Untreated aneurysma | Maintain SBP 120-140 mmHg |
| PCWP 12-14 mmHg | |
| Cl 3,5-4,5 L/min/m3 | |
| CCB | |
Reference guide for the management of vasospasm in patients with SAH.
Abbreviations:
CCB: Calcium channel blockers
CI: cardiac index; DIND: delayed ischemic neurologic deficit
NS: normalsaline; PCWP: pulmonary capillary wedge pressure
SBP: systolic blood pressure; SVP: systemic venous pressure
TCD: trancranial doppler