Clinical outcomes of aneurysmal subarachnoid hemorrhage patients treated with oral diltiazem and limited intensive care management

BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) patients are frequently treated wi th prophylactic nimodipine and undergo invasive monitoring of blood pressur e and volume status in an intensive care unit (ICU) setting to decrease the incidence of delayed ischemic neurological deficit (DIND) and improve func tional outcomes. The goal of this study was to examine the incidence of DIN D and poor functional outcomes in a consecutive series of SAH patients trea ted with a different regimen of prophylactic oral diltiazem and limited use of intensive care monitoring. METHODS The study involved a consecutive series of 123 aneurysmal SAH patients trea ted by the senior author who were admitted within 72 hours of hemorrhage an d who never received nimodipine or nicardipine. Functional outcomes were gr aded using the Glasgow Outcome Scale (GOS). RESULTS Of the 123 patients identified, favorable outcomes (GOS 4 and 5) were achie ved in 74.8%. The incidence of DIND was 19.5%. Hypertensive, hypervolemic, hemodilutional (HHH) therapy was used in 10 patients (8.1%) and no patients were treated for DIND by endovascular means. Seven patients (5.7%) had a p oor functional outcome or death because of DIND and two of these were relat ed to complications of HHH therapy. These results were com-pared to contemp orary series of SAH patients managed with other treatment protocols. CONCLUSIONS Functional outcomes of patients treated with a regimen of oral diltiazem, l imited use of ICU monitoring and HHH therapy for DIND compare favorably wit h other contemporary series of SAH patients. (C) 2001 by Elsevier Science I nc.