Authors: Zoumprouli A. et al.
Current Opinion in Anesthesiology, October 2025. DOI: 10.1097/ACO.0000000000001533
This narrative review summarizes recent advances and evolving evidence in the critical care management of aneurysmal subarachnoid hemorrhage (aSAH), with a focus on studies published over the past 18 months. The authors highlight the growing emphasis on precision medicine, multidisciplinary management, and the integration of technology—including artificial intelligence and quantitative imaging—to optimize outcomes in this high-risk population.
Key updates include a reaffirmation that tight systolic blood pressure control below 160 mmHg before aneurysm securing remains central to rebleeding prevention. New prognostic approaches, such as the modified 5-item frailty index and advanced imaging analytics, may refine risk stratification and guide individualized care. Emerging evidence suggests that prophylactic lumbar cerebrospinal fluid drainage can lower the incidence of delayed cerebral ischemia (DCI) and improve neurological recovery.
Vasospasm management continues to evolve, with milrinone and CT perfusion–guided strategies under investigation. Blood transfusion practices are shifting toward a hemoglobin target of approximately 9 g/dl, balancing oxygen delivery with transfusion risks. Temperature management remains controversial, though current consensus favors maintaining normothermia between 36.0°C and 37.5°C with continuous monitoring to prevent fever-related complications.
The authors stress the need for multicenter trials to validate optimal thresholds for hemodynamic, hematologic, and thermal parameters, as well as to assess novel DCI-targeted interventions.
What You Should Know
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Maintaining systolic blood pressure below 160 mmHg reduces rebleeding risk before aneurysm securing.
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Frailty indices and quantitative imaging tools improve outcome prediction in aSAH.
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Prophylactic lumbar drainage may prevent DCI and enhance recovery.
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Hemoglobin thresholds near 9 g/dl and normothermic temperature management are supported by current evidence.
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Future studies should refine individualized, technology-supported critical care strategies for aSAH.
Thank you to Current Opinion in Anesthesiology for publishing this timely review highlighting precision-based, multidisciplinary approaches to aneurysmal subarachnoid hemorrhage care.