Abstract：
BACKGROUND: In aneurysmal subarachnoid hemorrhage (aSAH), rebleeding of the culprit aneurysm is associated with significant morbidity and mortality. Blood pressure reduction to specific target levels, with the goal of preventing rebleeding, has been a mainstay of care prior to definitively securing the aneurysm. Clinical practice guidelines have recently changed and no longer recommend specific blood pressure targets. This survey aims to identify the reported practice patterns and beliefs regarding blood pressure management during the early phase of aSAH.
METHODS: We conducted a self-administered, Web-based survey of critical care physicians and cerebrovascular neurosurgeons practicing in Canada. The questionnaire contained 21 items, including 3 case-based scenarios to elicit blood pressure target selection, both before and after aneurysm securing.
RESULTS: In the presecured period, systolic blood pressures of 160 mm Hg (50% [144 of 287]) and 140 mm Hg (42% [120 of 287]) were the most frequently selected upper-limit targets. In the postsecured period, a systolic blood pressure of 180 mm Hg (32% [93 of 287]) was the most frequently selected upper-limit target, but there was a wide distribution of targets selected across all three cases ranging from 100 to > 200 mm Hg. A mean arterial pressure of 65 mm Hg was the most common lower-limit target in both the presecured and postsecured periods. There was little change in blood pressure targets with increasing clinical severity. Predictors of higher or lower blood pressure target selection and barriers to implementation of the desired target were identified.
CONCLUSIONS: During the presecured period, nearly half of the reported upper-limit blood pressure targets are lower than previous guideline recommendations. These targets remain consistent despite increasing clinical severity and could potentially exacerbate cerebral ischemia and negatively impact clinical outcomes. In the postsecured period, there is wide variation in the reported blood pressure targets. A clinical trial is urgently needed to guide decision-making.
METHODS: We conducted a self-administered, Web-based survey of critical care physicians and cerebrovascular neurosurgeons practicing in Canada. The questionnaire contained 21 items, including 3 case-based scenarios to elicit blood pressure target selection, both before and after aneurysm securing.
RESULTS: In the presecured period, systolic blood pressures of 160 mm Hg (50% [144 of 287]) and 140 mm Hg (42% [120 of 287]) were the most frequently selected upper-limit targets. In the postsecured period, a systolic blood pressure of 180 mm Hg (32% [93 of 287]) was the most frequently selected upper-limit target, but there was a wide distribution of targets selected across all three cases ranging from 100 to > 200 mm Hg. A mean arterial pressure of 65 mm Hg was the most common lower-limit target in both the presecured and postsecured periods. There was little change in blood pressure targets with increasing clinical severity. Predictors of higher or lower blood pressure target selection and barriers to implementation of the desired target were identified.
CONCLUSIONS: During the presecured period, nearly half of the reported upper-limit blood pressure targets are lower than previous guideline recommendations. These targets remain consistent despite increasing clinical severity and could potentially exacerbate cerebral ischemia and negatively impact clinical outcomes. In the postsecured period, there is wide variation in the reported blood pressure targets. A clinical trial is urgently needed to guide decision-making.
摘要：
背景：在动脉瘤性蛛网膜下腔出血（aSAH）中，罪犯动脉瘤的再出血与显著的发病率和死亡率相关.血压降低到特定的目标水平，为了防止再出血，在明确确保动脉瘤之前，一直是护理的支柱。临床实践指南最近发生了变化，不再推荐特定的血压目标。这项调查旨在确定在aSAH早期阶段有关血压管理的实践模式和信念。
方法：我们进行了自我管理，基于网络的加拿大重症监护医师和脑血管神经外科医生调查。问卷包含21个项目，包括3种基于病例的方案来引发血压目标选择，动脉瘤固定之前和之后。
结果：在预产期，160mmHg(50%[287中的144])和140mmHg(42%[287中的120])的收缩压是最常选择的上限目标.在担保后期间，收缩压180mmHg（32%[287中的93]）是最常选择的上限目标，但是在所有三个病例中选择的目标分布广泛，范围从100到>200mmHg。65mmHg的平均动脉压是固定前和固定后时期最常见的下限目标。随着临床严重程度的增加，血压目标几乎没有变化。确定了较高或较低血压目标选择的预测因子以及实现所需目标的障碍。
结论：在预产期，报告的上限血压目标中有近一半低于以前的指南建议.尽管临床严重程度增加，但这些目标仍然保持一致，并可能加剧脑缺血并对临床结果产生负面影响。在担保后期间，报告的血压目标差异很大。迫切需要临床试验来指导决策。
方法：我们进行了自我管理，基于网络的加拿大重症监护医师和脑血管神经外科医生调查。问卷包含21个项目，包括3种基于病例的方案来引发血压目标选择，动脉瘤固定之前和之后。
结果：在预产期，160mmHg(50%[287中的144])和140mmHg(42%[287中的120])的收缩压是最常选择的上限目标.在担保后期间，收缩压180mmHg（32%[287中的93]）是最常选择的上限目标，但是在所有三个病例中选择的目标分布广泛，范围从100到>200mmHg。65mmHg的平均动脉压是固定前和固定后时期最常见的下限目标。随着临床严重程度的增加，血压目标几乎没有变化。确定了较高或较低血压目标选择的预测因子以及实现所需目标的障碍。
结论：在预产期，报告的上限血压目标中有近一半低于以前的指南建议.尽管临床严重程度增加，但这些目标仍然保持一致，并可能加剧脑缺血并对临床结果产生负面影响。在担保后期间，报告的血压目标差异很大。迫切需要临床试验来指导决策。
