GUIDELINES FOR THE MANAGEMENT OF SPONTANEOUS ICH- A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association-2010

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GUIDELINES FOR THE MANAGEMENT OF SPONTANEOUS ICH- A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association-2010

Hariprakash
ICP based treatment rpotocol Recommendations For ICP Monitoring 1. Patients with a GCS score of <8, those with clinical evidence of transtentorial herniation, or those with significant IVH or hydrocephalus might be considered for ICP monitoring and treatment. 2. A cerebral perfusion pressure of 50 to 70 mm Hg may be reasonable to maintain depending on the status of cerebral autoregulation (Class IIb; LOE:C). (New recommendation) 3. Ventricular drainage as treatment for hydrocephalus is reasonable in patients with decreased level of consciousness (Class IIa; LOE: B). (New recommendation) GUIDELINES SURGERY 1. For most patients with ICH, the usefulness of surgery is uncertain expect (Class IIb; Level of Evidence: C). (New recommendation) 2. Patients with cerebellar hemorrhage with neurological deteriration/ evidence of brainstem compression and/or hydrocephalus from ventricular obstruction (Class I; Level of Evidence: B). (Revised from the previous guideline) 3.Initial treatment of these patients with ventricular drainage alone rather than surgical evacuation is not recommended (Class III; Level of Evidence: C). (New recommendation) 4. For patients presenting with lobar clots >30 mL and within 1 cm of the surface (Class IIb; Level of Evidence: B). (Revised from the previous guideline) The effectiveness of minimally invasive clot evacuation utilizing either stereotactic or endoscopic aspiration with or without thrombolytic usage is uncertain and is considered investigational (Class IIb; Level of Evidence: B). (New recommendation) No clear evidence for ultra-early removal of supratentorial. Very early craniotomy may be harmful due to increased risk of recurrent bleeding (Class III; Level of Evidence: B). (Revised from the previous guideline) CAVEAT: Among the limitations of ICH surgical trials is that young and middle-aged patients at risk of herniation from large ICHs were unlikely to be randomized for treatment