Neurocit Carehttps::/dol.org/10.1007s12028-023-01713-5NEURCRITICALCARE SOCIETYNCS GUIDELINESGuidelines for the Neurocritical CareManagement of Aneurysmal SubarachnoidHemorrhageMiriam M.Treggiari,Alejandro A.Rabinstein2,Katharina M.Busl,Meghan M.Caylor,Giuseppe Citerio13,Steven Deem,Michael Diringer5,Elizabeth Fox5,Sarah Livesay',Kevin N.Sheth,Jose I.Suarezand Stavropoula Tjoumakaris102023 Springer ScenceBusiness Media,LLC,part of Springer Nature and Neurocritical Care SocietyAbstractBackground:The neurointensive care management of patients with aneurysmal subarachnoid hemorrhage(aSAH)is one of the most critical components contributing to short-term and long-term patient outcomes.Previous recom-mendations for the medical management of aSAH comprehensively summarized the evidence based on consensusconference held in 2011.In this report,we provide updated recommendations based on appraisal of the literatureusing the Grading of Recommendations Assessment,Development,and Evaluation methodology.Methods:The Population/Intervention/Comparator/Outcome(PICO)questions relevant to the medical manage-ment of aSAH were prioritized by consensus from the panel members.The panel used a custom-designed surveyinstrument to prioritize clinically relevant outcomes specific to each PICO question.To be included,the study designqualifying criteria were as follows:prospective randomized controlled trials(RCTs),prospective or retrospectiveobservational studies,case-control studies,case series with a sample larger than 20 patients,meta-analyses,restrictedto human study participants.Panel members first screened titles and abstracts,and subsequently full text review ofselected reports.Data were abstracted in duplicate from reports meeting inclusion criteria.Panelists used the Gradingof Recommendations Assessment,Development,and Evaluation Risk of Bias tool for assessment of RCTs and the "Riskof Bias In Nonrandomized Studies-of Interventions'tool for assessment of observational studies.The summary oftheevidence for each PICO was presented to the full panel,and then the panel voted on the recommendations.Results:The initial search retrieved 15,107 unique publications,and 74 were included for data abstraction.SeveralRCTs were conducted to test pharmacological interventions,and we found that the quality of evidence for non-pharmacological questions was consistently poor.Five PICO questions were supported by strong recommendations,one PICO question was supported by conditional recommendations,and six PICO questions did not have sufficientevidence to provide a recommendation.Conclusions:These guidelines provide recommendations for or against interventions proven to be effective,inef-fective,or harmful in the medical management of patients with aSAH based on a rigorous review of the available lit-erature.They also serve to highlight gaps in knowledge that should guide future research priorities.Despite improve-ments in the outcomes of patients with aSAH over time,many important cli
