2024
Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist
Robba C, Busl K, Claassen J, Diringer M, Helbok R, Park S, Rabinstein A, Treggiari M, Vergouwen M, Citerio G. Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist. Intensive Care Medicine 2024, 50: 646-664. PMID: 38598130, PMCID: PMC11078858, DOI: 10.1007/s00134-024-07387-7.Peer-Reviewed Original ResearchMeSH KeywordsAneurysm, RupturedCritical CareHumansIntensive Care UnitsPrognosisSubarachnoid HemorrhageConceptsIntensive care unitAneurysmal subarachnoid haemorrhageRuptured aneurysmsLong-term prognostic factorsRisk of rebleedingIntensive care unit managementRobust clinical evidenceDelayed cerebral ischaemiaExpert clinical experienceSecondary brain damageDeterminants of functional outcomePrognostic factorsASAH patientsPrompt diagnosisHaemodynamic monitoringClinical evidenceMorbidity rateSpecialized centersTreatment strategiesClinical trialsContemporary guidelinesPatient populationFunctional outcomesCare unitCerebral ischaemia
2021
A Double-Blind, Randomized, Placebo-Controlled Trial of Soluble Epoxide Hydrolase Inhibition in Patients with Aneurysmal Subarachnoid Hemorrhage
Martini RP, Siler D, Cetas J, Alkayed NJ, Allen E, Treggiari MM. A Double-Blind, Randomized, Placebo-Controlled Trial of Soluble Epoxide Hydrolase Inhibition in Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care 2021, 36: 905-915. PMID: 34873674, DOI: 10.1007/s12028-021-01398-8.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCerebral InfarctionCyclohexylaminesDouble-Blind MethodEnzyme InhibitorsEpoxide HydrolasesHumansSubarachnoid HemorrhageTriazinesConceptsSoluble epoxide hydrolaseAneurysmal subarachnoid hemorrhageSubarachnoid hemorrhageDHET ratiosEnd pointDay 7Day 10Primary study end pointSoluble epoxide hydrolase inhibitionCSF inflammatory cytokinesEET/DHET ratiosIncidence of DCIPrevention of DCITertiary end pointSecondary end pointsStudy end pointCerebral blood flowLength of stayEndothelial injury biomarkersEpoxide hydrolase inhibitionNeurovascular inflammationResultsTen patientsStudy drugAdverse eventsCytokine levels
2015
Randomized Pilot Trial of Intensive Management of Blood Pressure or Volume Expansion in Subarachnoid Hemorrhage (IMPROVES)
Togashi K, Joffe AM, Sekhar L, Kim L, Lam A, Yanez D, Broeckel-Elrod JA, Moore A, Deem S, Khandelwal N, Souter MJ, Treggiari MM. Randomized Pilot Trial of Intensive Management of Blood Pressure or Volume Expansion in Subarachnoid Hemorrhage (IMPROVES). Neurosurgery 2015, 76: 125-135. PMID: 25549192, DOI: 10.1227/neu.0000000000000592.Peer-Reviewed Original ResearchConceptsRankin Scale scoreCerebral ischemiaSubarachnoid hemorrhageCBP groupBlood pressureLarge trialsPilot trialScale scoreOptimal blood pressure managementSystolic blood pressure differenceModified Rankin Scale scoreBlood pressure manipulationIntravenous fluid intakeWorse neurobehavioral outcomesBlood pressure managementBlood pressure differenceDelayed Cerebral IschemiaRandomized pilot trialPulmonary complicationsAdverse eventsDischarge dispositionHemodynamic managementStudy endpointPatient populationProtocol adherence
2014
Assessment of Circulating Blood Volume with Fluid Administration Targeting Euvolemia or Hypervolemia
Joffe AM, Khandelwal N, Hallman MR, Treggiari MM. Assessment of Circulating Blood Volume with Fluid Administration Targeting Euvolemia or Hypervolemia. Neurocritical Care 2014, 22: 82-88. PMID: 25142828, DOI: 10.1007/s12028-014-9993-8.Peer-Reviewed Original ResearchConceptsSubgroup of patientsBlood volumeHV groupDay 5Fluid administrationFluid balanceDelayed ischemic neurologic deficitsCrystalloid fluid administrationIschemic neurologic deficitCumulative fluid balanceML/Higher fluid balanceT-testStudent's t-testProphylactic hypervolemiaICU admissionICU stayResultsTwenty patientsNeurologic deficitsCerebral vasospasmClinical trialsHypervolemiaNormovolemiaBVA-100Concurrent group
2013
Validity of Exchangeable Solute Balance as a Measure of Blood Volume in Neurologically Injured Adults
Joffe AM, Healey L, Khandelwal N, Hallman MR, Van Cleve W, Treggiari MM. Validity of Exchangeable Solute Balance as a Measure of Blood Volume in Neurologically Injured Adults. Neurocritical Care 2013, 21: 102-107. PMID: 24057812, DOI: 10.1007/s12028-013-9915-1.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedBlood VolumeBlood Volume DeterminationExtracellular FluidFemaleHumansMaleMiddle AgedReproducibility of ResultsSubarachnoid HemorrhageWater-Electrolyte BalanceConceptsBlood volumeFluid balanceNeuroscience intensive care unitBV measurementsExtracellular fluidConsecutive adult patientsLarge academic medical centerIntensive care unitAcademic medical centerBV testResults55 patientsAdult patientsRoutine careCare unitTotal body waterCapillary leakActual blood volumeMedical CenterRobust variance estimationBVA-100MethodsThe UniversityAlbumin injectionNumber of daysPatientsBody water
2011
Hemodynamic Management of Subarachnoid Hemorrhage
Treggiari MM, Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage. Hemodynamic Management of Subarachnoid Hemorrhage. Neurocritical Care 2011, 15: 329. PMID: 21786046, DOI: 10.1007/s12028-011-9589-5.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseBlood VolumeCritical CareFluid TherapyHemodilutionHumansSubarachnoid HemorrhageConceptsHemodynamic augmentation therapyHemodynamic augmentationUnsecured aneurysmsAugmentation therapySubarachnoid hemorrhageHigher cerebral blood flowBlood pressure augmentationBlood pressure managementCerebral blood flowElectronic literature searchEnglish language papersInotropic therapyCerebral ischemiaHemodynamic managementVolume statusInotropic agentsStandard treatmentSymptom reversalAneurysmal ruptureEligible reportsBlood flowSide effectsPatientsPressure augmentationIncremental riskThe association between fluid balance and outcomes after subarachnoid hemorrhage
Martini RP, Deem S, Brown M, Souter MJ, Yanez ND, Daniel S, Treggiari MM. The association between fluid balance and outcomes after subarachnoid hemorrhage. Neurocritical Care 2011, 17: 191-198. PMID: 21688008, DOI: 10.1007/s12028-011-9573-0.Peer-Reviewed Original ResearchConceptsPositive fluid balanceICU day 3Negative fluid balanceFluid balanceNew strokeSubarachnoid hemorrhageDay 3Early fluid balanceLevel 1 traumaCumulative fluid balanceWorse clinical presentationMultivariable logistic regressionLess urine outputHunt-Hess scoreGreater resource useTCD vasospasmHospital deathHospital mortalityICU admissionTroponin elevationAdmission GCSHospital courseHospital lengthAdult patientsPrimary outcome
2010
Current Practices of Triple-H Prophylaxis and Therapy in Patients with Subarachnoid Hemorrhage
Meyer R, Deem S, David Yanez N, Souter M, Lam A, Treggiari MM. Current Practices of Triple-H Prophylaxis and Therapy in Patients with Subarachnoid Hemorrhage. Neurocritical Care 2010, 14: 24-36. PMID: 20838932, DOI: 10.1007/s12028-010-9437-z.Peer-Reviewed Original ResearchConceptsNeurointensive care unitSubarachnoid hemorrhagePercent of respondentsProphylactic hypervolemiaHemodilution therapySymptomatic vasospasmCerebral vasospasmDedicated neurointensive care unitsDiagnostic approachMean arterial pressureCentral venous cathetersSystolic blood pressureEvidence of vasospasmAneurysmal subarachnoid hemorrhageNeurocritical Care SocietyTarget of therapyBackgroundMedical managementLonger ICULack of evidenceVenous cathetersArterial pressureBlood pressureCare unitHalf of respondentsPressure titration
2009
Which H is the most important in triple-H therapy for cerebral vasospasm?
Treggiari MM, Deem S. Which H is the most important in triple-H therapy for cerebral vasospasm? Current Opinion In Critical Care 2009, 15: 83-86. PMID: 19276798, DOI: 10.1097/mcc.0b013e32832922d1.Peer-Reviewed Original ResearchMeSH KeywordsBlood CirculationBlood VolumeCerebrovascular CirculationHemodilutionHemodynamicsHumansHypertensionSubarachnoid HemorrhageVasospasm, IntracranialConceptsCerebral vasospasmSubarachnoid hemorrhageCirculatory volume expansionNew randomized trialsCerebral blood flowHemodynamic managementRandomized trialsHemodynamic variablesHypervolemic hemodilutionRegistry databaseBlood flowPaucity of informationVasospasmPhysiologic dataHemorrhagePhysiological studiesLow levelsHypertensionComplicationsHemodilutionTherapyRecent literatureTrialsAccuracy of transcranial Doppler ultrasonography and single-photon emission computed tomography in the diagnosis of angiographically demonstrated cerebral vasospasm.
Kincaid MS, Souter MJ, Treggiari MM, Yanez ND, Moore A, Lam AM. Accuracy of transcranial Doppler ultrasonography and single-photon emission computed tomography in the diagnosis of angiographically demonstrated cerebral vasospasm. Journal Of Neurosurgery 2009, 110: 67-72. PMID: 18821830, DOI: 10.3171/2008.4.17520.Peer-Reviewed Original ResearchConceptsAnterior cerebral arteryMiddle cerebral arteryTranscranial Doppler ultrasonographyPosterior cerebral arteryTCD ultrasonographyBasilar arteryCerebral arteryDoppler ultrasonographyOdds ratioAbsence of vasospasmInstitutional review board approvalRecords of patientsReview board approvalSingle photon emissionRoutine clinical useCerebral angiographyCerebral vasospasmMean ageSubarachnoid hemorrhageVascular territoriesSPECT evaluationVasospasmRelative oddsBoard approvalUltrasonography
2003
Systematic review of the prevention of delayed ischemic neurological deficits with hypertension, hypervolemia, and hemodilution therapy following subarachnoid hemorrhage.
Treggiari MM, Walder B, Suter PM, Romand JA. Systematic review of the prevention of delayed ischemic neurological deficits with hypertension, hypervolemia, and hemodilution therapy following subarachnoid hemorrhage. Journal Of Neurosurgery 2003, 98: 978-84. PMID: 12744357, DOI: 10.3171/jns.2003.98.5.0978.Peer-Reviewed Original ResearchConceptsDelayed ischemic neurological deficitsIschemic neurological deficitsHemodilution therapyNeurological deficitsSubarachnoid hemorrhageMethodological qualitySystematic reviewSummary relative risk estimatesRisk of deathMajor end pointsInternal validity scoreRelative risk estimatesStudy methodological qualityRandom-effects modelClinical vasospasmSymptomatic vasospasmCerebral vasospasmRegister searchMAIN OUTCOMEValidity scoresReference listsPaucity of informationVasospasmEnd pointRisk estimatesCervical Sympathetic Block to Reverse Delayed Ischemic Neurological Deficits After Aneurysmal Subarachnoid Hemorrhage
Treggiari MM, Romand JA, Martin JB, Reverdin A, Rüfenacht DA, de Tribolet N. Cervical Sympathetic Block to Reverse Delayed Ischemic Neurological Deficits After Aneurysmal Subarachnoid Hemorrhage. Stroke 2003, 34: 961-966. PMID: 12649526, DOI: 10.1161/01.str.0000060893.72098.80.Peer-Reviewed Original ResearchConceptsCervical sympathetic blockAneurysmal subarachnoid hemorrhageSympathetic blockCerebral perfusionNeurological statusCerebral vasospasmSubarachnoid hemorrhageMaximal medical treatmentCervical sympathetic chainIschemic neurological deficitsSuperior cervical ganglionConfirmatory angiographyHorner's signIschemic deficitsLocoregional treatmentNeurological deficitsSevere vasospasmStandard therapyCerebral angiographyConsecutive patientsSympathetic chainLocoregional anesthesiaCervical ganglionInitial hemorrhageModerate symptoms