Preventing delayed cerebral ischemia in secured aneurysmal subarachnoid haemorrhage, in an era after the fall of triple-H therapy: a narrative overview for nurses

Objective This literature review aims to identify relevant nursing strategies that could prevent delayed cerebral ischemia (DCI) in aneurysmal subarachnoid haemorrhage (ASAH) and explore future research directions. Background Delayed cerebral ischemia is one of the deleterious sequels of ASAH. Triple-H therapy, which used to be the mainstay of DCI prevention, is deemed outdated due to its adverse effects. Despite the advancements in the management of ASAH and DCI, the morbidity and mortality from these conditions remain high. Therefore, a literature review was conducted to identify key relevant nursing strategies in contemporary practice for preventing DCI. Study design and methods A narrative literature review, known as a narrative overview, was undertaken to critique and synthesise the selected scholarly articles retrieved from electronic databases and hand searches. Results After quality appraisal, 41 articles, including seven seminal articles, were chosen to support this review. Conclusion Despite current management strategies, DCI mortality and morbidity remain high in ASAH. Standard guidelines emphasise monitoring for DCI, administering enteral nimodipine, and maintaining euvolemia. Additional key considerations include managing normoglycemia, normoxia, normothermia, and preventing hypotension. However, optimising euvolemia, normoxia, and targeted temperature management remains a complex process. Future research is needed to develop reliable bedside tools for assessing circulatory blood volume and establishing precise oxygen levels and temperature thresholds to enhance DCI prevention and improve neurological outcomes in ASAH patients.