Bundled Treatments in Poor-Grade Subarachnoid Hemorrhage: Do They Help?

Excerpt

Aneurysmal subarachnoid hemorrhage (SAH), a hemorrhagic stroke affecting a relatively young population, has major socioeconomic implications. Although it accounts for ~ 5% strokes worldwide, its cost burden is disproportionate, extending beyond the acute phase of the disease and into the postacute phase, and includes physical and (often under-recognized) cognitive rehabilitation followed by societal reintegration. Advancement in neurocritical care over the past 2–3 decades, along with development of specialized neurocritical care units, has resulted in decreased mortality, but morbidity remains high, especially among those with severe-grade SAH (i.e., Hunt and Hess [H&H] grades IV and V: comatose at presentation). It is also a complex disease that not only involves the brain (at the time of ictus and beyond) but also has multisystem manifestations. Several specialists and ancillary health care professionals need to work in collaboration to provide optimal outcome for such patients, including but not limited to the neurosurgeon, neurointensivist, interventional neuroradiologist, neuroscience nursing staff, respiratory therapist, nutritionist, and physical and occupational therapist. Hence, as a complex disease managed in a critical care setting, SAH is a recipe for practice variations and thus suboptimal patient outcome. To address such problems in the intensive care unit (ICU), most US hospitals have adopted a “bundle” care delivery model as recommended by the US Institute of Healthcare Improvement (IHI). …