CARDIAC-PERFORMANCE ENHANCEMENT FOR THE P REVENTION AND TREATMENT OF DELAYED CEREBRAL-ISCHEMIA DUE TO VASOSPASM

Following subarachnoid haemorrhage, delayed cerebral ischaemia from ce rebral vasospasm remains the most important cause of mortality and mor bidity in patients with surgically secured aneurysms. Therapy with hae modilution, hypertension and volume expansion has been recommended to prevent and treat delayed cerebral ischaemia in these patients on the basis of uncontrolled clinical series (level of evidence III to V, gra de C recommendation). Despite the lack of controlled studies, the main tenance of a cardiac index > 3.5 L . min(-1).m(-2) and a systolic arte rial pressure between 120 and 150 mmHg before clipping and 160 to 200 mmHg thereafter is recommended as a prophylactic or therapeutic measur e for vasospasm. Close monitoring of neurological and cardiorespirator y status is important to avoid neurologic and systemic complications.