From the Research
For a healing subdural hematoma post mobilization, maintaining a systolic blood pressure between 100-150 mmHg is generally recommended, as it does not show a statistical difference in mortality or secondary outcomes compared to a higher range, as demonstrated by a recent study 1. This range provides adequate cerebral perfusion while minimizing the risk of rebleeding. Blood pressure management should be individualized based on the patient's baseline blood pressure, age, and comorbidities. Some key points to consider in managing blood pressure for a healing subdural hematoma include:
- Antihypertensive medications such as labetalol or nicardipine may be used for acute management, with careful titration to avoid hypotension.
- For ongoing control, oral medications like amlodipine, lisinopril, or metoprolol can be effective.
- Regular monitoring is essential, with blood pressure checks every 1-2 hours initially, then every 4 hours as the patient stabilizes.
- The goal is to balance the need to maintain cerebral perfusion pressure while preventing hypertension that could exacerbate bleeding or cerebral edema during the critical healing phase of a subdural hematoma. A study from 2022 found that patients with mean systolic blood pressure <140 in the first 24 h of admission had a lower rate of hematoma expansion than those with SBP > 140 2. However, the most recent and highest quality study, which is the one from 2022 1, should be prioritized, and it suggests that maintaining a systolic blood pressure between 100-150 mmHg does not show a statistical difference in mortality or secondary outcomes compared to a higher range. Therefore, this range is recommended for managing a healing subdural hematoma post mobilization.