From the Guidelines
For patients with acute subdural hematoma (SDH), the goal blood pressure range should be maintained between 140-160 mmHg to reduce the risk of hematoma expansion and improve outcomes, as suggested by the most recent guidelines 1. The management of blood pressure in acute SDH is crucial to prevent secondary brain injury and improve patient outcomes.
- The goal is to maintain adequate cerebral perfusion while minimizing the risk of hematoma expansion.
- A systolic blood pressure range of 140-160 mmHg is recommended, as it has been shown to reduce the risk of hematoma expansion and improve neurological recovery 1.
- Excessive acute drops in systolic blood pressure (>70 mmHg) should be avoided, as they may be associated with acute renal injury and early neurological deterioration 1.
- The choice of blood pressure-lowering agents should be based on the patient's individual needs and medical history, with titratable intravenous agents such as labetalol, nicardipine, or clevidipine being suitable options.
- Closer monitoring and tighter control may be warranted in the immediate post-injury phase, particularly if the patient has uncontrolled intracranial pressure (ICP).
- Blood pressure goals should be individualized based on the patient's baseline blood pressure, presence of other injuries, and neurological status, as suggested by previous studies 1.
From the Research
Goal Blood Pressure Range for Acute SDH
The goal blood pressure range for acute subdural hematoma (SDH) is a topic of ongoing debate.
- A study published in 2022 2 found that maintaining a systolic blood pressure (SBP) between 100-150mmHg or below 180mmHg did not have a significant difference in mortality or secondary outcomes in patients with acute traumatic SDH.
- Another study from 2014 3 focused on intracerebral hemorrhage, but also discussed the importance of blood pressure management, suggesting that SBP should be maintained between 120 and 160 mmHg.
- A 2012 study 4 on acute intracerebral hemorrhage found that lowering SBP to 160 mmHg or less using nicardipine appeared to be well tolerated and feasible.
- A study on acute subdural hematomas in critical conditions 5 highlighted the significance of monitoring initial intracranial pressure, but did not provide specific blood pressure targets.
- Research from 2022 6 investigated cerebral blood flow disorder in acute subdural hematoma and acute intraoperative brain bulge, but did not directly address the goal blood pressure range.
Key Findings
- The ideal blood pressure range for acute SDH patients is not clearly defined, but maintaining SBP between 100-150mmHg or below 180mmHg may be considered based on available evidence 2.
- Blood pressure management is crucial in acute intracerebral hemorrhage, with targets ranging from 120 to 160 mmHg 3, 4.
- Further research is needed to determine the optimal blood pressure range for acute SDH patients, considering factors such as cerebral perfusion pressure and the risk of hematoma expansion.