Skip to main content
SpringerLink
Log in

Non-traumatic Subarachnoid Hemorrhage

  • Conference paper
Intensive Care Medicine

  • 981 Accesses

Abstract

Non-traumatic subarachnoid hemorrhage (SAH) has distinct risk factors, demographics, and treatment from other forms of stroke. Spontaneous SAH, mostly aneurysmal, accounts for about 2–5% of all strokes, afflicting 37,500 cases of stroke per year in the United States [1]. A cerebral aneurysm is an outpouching of the brain arteries that eventually ruptures. The incidence of non-traumatic aneurysmal SAH has remained stable over the past 30 years [2]. Although the incidence of non-traumatic SAH varies from region to region, the aggregate worldwide incidence is about 10.5 per 100,000 person years [3, 4]. Women have a 1.6 times (95% confidence interval [CI] 1.5–2.3) higher risk than men [5] and people of African descent a 2.1 times (95% CI 1.3–3.6) higher risk than whites [6]. The major risk factors for non-traumatic SAH include cigarette smoking, hypertension, cocaine use, and habitual heavy alcohol intake [7]. Other factors, such as a family history of first-degree relatives with the disease and heritable connective-tissue disorders, also play a role [7].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Mayberg MR, Batjer HH, Dacey R, et al (1994) Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 25:2315–2328

    CAS  PubMed  Google Scholar 

  2. van Gijn J, Rinkel JE (2001) Subarachnoid haemorrhage: diagnosis, causes and management. Brain 124:249–278

    Article  PubMed  Google Scholar 

  3. Linn FH, Rinkel GJ, Algra A, van Gijn J (1996) Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke 27:625–629

    CAS  PubMed  Google Scholar 

  4. Suarez JI, Tarr RW, Selman WR (2006) Aneurysmal subarachnoid hemorrhage. N Engl J Med 354:387–396

    Article  CAS  PubMed  Google Scholar 

  5. Lindsay KW, Teasdale GM, Knill-Jones RP (1983) Observer variability in assessing the clinical features of subarachnoid hemorrhage. J Neurosurg 58:57–62

    CAS  PubMed  Google Scholar 

  6. Broderick JP, Brott T, Tomsick T, Huster G, Miller R (1992) The risk of subarachnoid hemorrhage and intracerebral hemorrhages in blacks as compared to whites. N Engl J Med 326: 733–736

    Article  CAS  PubMed  Google Scholar 

  7. Hop JW, Rinkel GJ, Algra A, van Gijn J (1997) Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 28:660–664

    CAS  PubMed  Google Scholar 

  8. Roos YBWEM, Dijkgraaf MGW, Albrecht KW, et al (2002) Direct costs of modern treatment of aneurysmal subarachnoid hemorrhage in the first year after diagnosis. Stroke 33:1595–1599

    Article  CAS  PubMed  Google Scholar 

  9. Edlow JA, Caplan LR (2000) Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med 342:29–36

    Article  CAS  PubMed  Google Scholar 

  10. Polmear A (2003) Sentinel headaches in aneurismal subarachnoid hemorrhage: what is the true incidence? A systematic review. Cephalalgia 23:935–941

    Article  CAS  PubMed  Google Scholar 

  11. Botterell EH, Lougheed WM, Scott JW, Vanderwater SL (1956) Hypothermia and interruption of carotid and vertebral circulation in the surgical management of intracranial aneurysms. J Neurosurg 13:1–42

    CAS  PubMed  Google Scholar 

  12. Hunt WE, Hess RM (1968) Surgical risk as related to time intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20

    CAS  PubMed  Google Scholar 

  13. Drake CG (1968) Report of World Federation of Neurological Surgeons (committee on a universal subarachnoid hemorrhage grading scale (Neurosurgical forum). J Neurosurg 68:985–986

    Google Scholar 

  14. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computed tomographic scanning. Neurosurgery 6:1–9

    Article  CAS  PubMed  Google Scholar 

  15. Claassen J, Bernardini GL, Kreiter K, et al (2001) Effect of cisternal and ventricular blood on risk pf delayed cerebral ischemia after subarachnoid hemorrhage. The Fisher Scale revisited. Stroke 32:2012–2020

    Article  CAS  PubMed  Google Scholar 

  16. Hijdra A, Vermeulen M, van Gijn J, van Crevel H (1987) Rerupture of intracranial aneurysms: a clinicoanatomic study. J Neurosurg 67:29–33

    CAS  PubMed  Google Scholar 

  17. Locksley HB (1966) Natural history of subarachnoid hemorrhage, intracranial aneurysms, and arteriovenous malformations. J Neurosurg 25:321–368

    Article  CAS  PubMed  Google Scholar 

  18. Hijdra A, van Gijn J, Nagelkerke NJD, Vermeulen M, van Crevel H (1988) Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage. Stroke 19:1250–1256

    CAS  PubMed  Google Scholar 

  19. Chyatte D, Fode NC, Sundt TM (1988) Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage. J Neurosurg 69:326–331

    Article  CAS  PubMed  Google Scholar 

  20. Haley EC, Kassell NF, Torner JC (1992) The International Cooperative Study on the timing of aneurysm surgery. The North American experience. Stroke 23:205–214

    PubMed  Google Scholar 

  21. Kassell NF, Torner JC, Haley EC, et al (1990) The International Cooperative Study on the timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:18–36

    CAS  PubMed  Google Scholar 

  22. Kassell NF, Torner JC, Jane JA, Haley EC, Adams HP (1990) The International Cooperative Study on the timing of aneurysm surgery. Part 2; surgical results. J Neurosurg 73:37–47

    Article  CAS  PubMed  Google Scholar 

  23. Solenski N, Haley EC, Kassell NF, et al (1995) Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Crit Care Med 23:1007–1017

    Article  CAS  PubMed  Google Scholar 

  24. van Gijn J, Hijdra A, Widjicks EFM, Vermeulen M, van Crevel H (1985) Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 63:355–362

    PubMed  Google Scholar 

  25. Hijdra A, van Gijn J, Stefanko S, van Dongen KJ, Vermeulen M, van Crevel H (1986) Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations. Neurology 36:329–333

    CAS  PubMed  Google Scholar 

  26. Mayberg MR, Batjer HH, Dacey R, et al (1994) Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 25:2315–2328

    CAS  PubMed  Google Scholar 

  27. Heros RC, Zervas NT, Varsos V (1983) Cerebral vasospasm after subarachnoid hemorrhage: an update. Ann Neurol 14:599–608

    Article  CAS  PubMed  Google Scholar 

  28. Fletcher TM, Taveras JM, Pool JL (1959) Cerebral vasospasm in angiography for intracranial aneurysms: incidence and significance in one hundred consecutive angiograms. Arch Neurol 1:38–47

    CAS  PubMed  Google Scholar 

  29. Graf C, Nibbelink DW (1974) Cooperative study of intracranail aneurysms and subarachnoid hemorrhage. Stroke 5:559–601

    Google Scholar 

  30. Haley EC, Kassell NF, Torner JC (1993) A randomized trial of nicardipine in subarachnoid hemorrhage: angiographic and transcranial Doppler ultrasound results. J Neurosurg 78:548–553

    PubMed  Google Scholar 

  31. Suarez JI, Qureshi AI, Yahia AB, et al (2002) Symptomatic vasospasm diagnosis after subarachnoid hemorrhage: evaluation of transcranial Doppler ultrasound and cerebral angiogrpahy as related to the compromised vascular distribution. Crit Care Med 30:1348–1355

    Article  PubMed  Google Scholar 

  32. Awad IA, Carter PL, Spetzler RF, Medina M, Willaims FW (1987) Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke 18:365–372

    CAS  PubMed  Google Scholar 

  33. Kassell NF, Peerles SJ, Durward QJ, Beck DW, Drake CG, Adams HP (1982) Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11:337–343

    Article  CAS  PubMed  Google Scholar 

  34. Muizelaar JP, Becker DP (1986) Induced hypertension for the treatment of cerebral ischemia after subarachnoid hemorrhage. Surg Neurol 25:317–325

    Article  CAS  PubMed  Google Scholar 

  35. Amin-Hanjani S, Schwartz RB, Sathi S, Stieg PE (1999) Hypertensive encephalopathy as a complication of hyperdynamic therapy for vasospasm: report of two cases. Neurosurgery 44:1113–1116

    Article  CAS  PubMed  Google Scholar 

  36. Fandino J, Kaku Y, Schuknecht B, Valvanis A, Yonekawa Y (1998) Improvement of cerebral oxygenation patterns and metabolic validation of superselective intraarterial infusion of papaverine for the treatment of cerebral vasospasm. J Neurosurg 89:93–100

    Article  CAS  PubMed  Google Scholar 

  37. Higashida RT, Halbach VV, Cahan LD, et al (1989) Transluminal angioplasty for treatment of intracranial arterial vasospasm. J Neurosurg 71:648–653

    CAS  PubMed  Google Scholar 

  38. Kaku Y, Yonekawa Y, Tsukahara T, Kazekawa K (1992) Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77:842–847

    Article  CAS  PubMed  Google Scholar 

  39. Newell DW, Eskridge JM, Mayberg MR, Grady MS, Winn HR (1989) Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. J Neurosurg 71:654–660

    Article  CAS  PubMed  Google Scholar 

  40. Dietrich HH, Dacey RG (2000) Molecular keys to the problems of cerebral vasospasm. Neurosurgery 46:517–530

    Article  CAS  PubMed  Google Scholar 

  41. Macdonald RL (2001) Pathophysiology and molecular genetics of vasospasm. Acta Neurochir S77:7–11

    Google Scholar 

  42. Gabikian P, Clatterbuck RE, Eberhart CG, Tyler BM, Tierney TS, Tamargo RJ (2002) Prevention of experimental cerebral vasospasm by intracranial delivery of a nitric oxide donor from a controlled-release polymer: toxicity and efficacy studies in rabbits and rats. Stroke 33:2681–2686

    Article  PubMed  Google Scholar 

  43. Juvela S (2002) Plasma endothelin and big endothelin concentrations and serum endothelin-converting enzyme activity following aneurismal subarachnoid hemorrhage. J Neurosurg 97:1287–1293

    CAS  PubMed  Google Scholar 

  44. McGirt MJ, Lynch JR, Parra A, et al (2002) Simvastatin increases endothelial nitric oxide synthase and ameliorates cerebral vasospasm resulting from subarachnoid hemorrhage. Stroke 33:2950–2956

    Article  CAS  PubMed  Google Scholar 

  45. Pilitsis JG, Coplin WM, O’Regan MH, et al (2002) Free fatty acids in human cerebrospinal fluid following subarachnoid hemorrhage and their potential role in vasospasm: a preliminary observation. J Neurosurg 97:272–279

    Article  CAS  PubMed  Google Scholar 

  46. Vatter H, Mursch K, Zimmerman M, et al (2002) Endothelin-converting enzyme activity in human cerebral circulation. Neurosurgery 51:445–451

    Article  PubMed  Google Scholar 

  47. Zuccarello M (2001) Endothelin: the “prime suspect” in cerebral vasospasm. Acta Neurochir S77:61–65

    CAS  Google Scholar 

  48. Bulter WE, Peterson JW, Zervas NT, Morgan KG (1996) Intracellular calcium, myosin light chain phosphorylation, and contractile force in experimental cerebral vasospasm. Neurosurgery 38:781–788

    CAS  PubMed  Google Scholar 

  49. Koide M, Nishizawa S, Ohta S, Yokoyama T, Namba H (2002) Chronological changes of the contractile mechanism in prolonged vasospasm after subarachnoid hemorrhage: from protein kinase C to protein tyrosine kinase. Neurosurgery 51:1468–1476

    Article  PubMed  Google Scholar 

  50. Laher I, Zhang JH (2001) Protein kinase C and cerebral vasospasm. J Cereb Blood Flow 21:887–906

    Article  CAS  Google Scholar 

  51. Clatterbuck RE, Oshiro EM, Hoffman PA, Dietsch GN, Pardoli DM, Tamargo RJ (2002) Inhibition of vasospasm with lymphocyte function-associated antigen-1 monoclonal antibody in a femoral artery model in rats. J Neurosurg 97:676–682

    Article  CAS  PubMed  Google Scholar 

  52. Mocco J, Mack WJ, Kim GH, et al (2002). Rise in serum soluble intercellular adhesion molecule-1 levels with vasospasm following aneurismal subarachnoid hemorrhage. J Neurosurg 97:537–541

    CAS  PubMed  Google Scholar 

  53. Sercombe R, Dinh YR, Gomis P (2002) Cerebrovascular inflammation following subarachnoid hemorrhage. Jpn J Pharmacol 88:227–249

    Article  CAS  PubMed  Google Scholar 

  54. Thai QA, Oshiro EM, Tamargo RJ (1999) Inhibition of experimental vasospam in rats with the periadventitial administration of ibuprofen using controlled-release polymers. Stroke 30:140–147

    CAS  PubMed  Google Scholar 

  55. Borel CO, McKee A, Parra A, et al (2003) Possible role for vascular cell proliferation in cerebral vasospasm after subarachnoid hemorrhage. Stroke 34:427–433

    Article  CAS  PubMed  Google Scholar 

  56. McGirt MJ, Lynch JR, Blessing R, et al (2002) Serum von Willebrand factor, matrix metallo-proteinase-9, and vascular-endothelial growth factor levels predict the onset of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 51:1128–1135

    Article  PubMed  Google Scholar 

  57. Ono S, Komuro T, Macdonald LR (2002) Heme oxygenase-1 gene therapy for prevention of vasospasm in rats. J Neurosurg 96:1094–1102

    CAS  PubMed  Google Scholar 

  58. Auer LM (1984) Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15:57–66

    Article  CAS  PubMed  Google Scholar 

  59. Flamm ES, Adams HP, Beck DW, et al (1988) Dose-escalation study of intravenous nicardipine in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 68:393–400

    Article  CAS  PubMed  Google Scholar 

  60. Gilsbach JM, Reulen HJ, Ljunggren B, et al (1990) Early aneurysm surgery and preventive therapy with intravenously administered nimodipine: a multicenter, double-blind, dose-comparison study. Neurosurgery 26:458–464

    Article  CAS  PubMed  Google Scholar 

  61. Petruk KC, West M, Mohr G, et al (1988) Nimodipine treatment in poor-grade aneurysm patients. J Neurosurg 68:505–517

    CAS  PubMed  Google Scholar 

  62. Pickard JD, Murray GD, Illingworth R, et al (1989) Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid hemorrhage: British aneurysm nimodipine trial. BMJ 298:636–642

    Article  CAS  PubMed  Google Scholar 

  63. Rinkel GJ, Feigin VL, Algra A, Vermeulen M, van Gijn J (2004) Calcium antagonists for aneurysmal subarachnoid hemorrhage. Cochrane Database Syst Rev 4:CD000277

    Google Scholar 

  64. Kassell NF, Haley EC, Apperson-Hansen C, Alves WM (1996) Randomized, double-blind, vehicle-controlled trial of tirilazad mesylate in patients with aneurysmal subarachnoid hemorrhage: a cooperative study in Europe, Australia, and New Zealand. J Neurosurg 84: 221–228

    CAS  PubMed  Google Scholar 

  65. Lanzino G, Kassell NF (1999) Double-blind, randomized, vehicle-controlled study of high-dose tirilazad mesylate in women with aneurysmal subarachnoid hemorrhage. Part II. A cooperative study in North America. J Neurosurg 90:1018–1024

    CAS  PubMed  Google Scholar 

  66. Asano T, Takakura K, Sano K, et al (1996) Effects of hydroxyl radical scavenger on delayed ischemic neurological deficits following aneurysmal subarachnoid hemorrhage: results of a multicenter, placebo-controlled double-blind trial. J Neurosurg 84:792–803

    CAS  PubMed  Google Scholar 

  67. Saito I, Asano T, Sano K, et al (1998) Neuroprotective effect of an antioxidant, ebselen, in patients with delayed neurological deficits after aneurysmal subarachnoid hemorrhage. Neurosurgery 42:269–277

    Article  CAS  PubMed  Google Scholar 

  68. Mendelow AD, Stockdill G, Steers AJ, Hayes J, Gilligham FJ (1982) Double-blind trial of aspirin in patients receiving tranexamic acid for subarachnoid hemorrhage. Acta Neurochir (Wien) 62:195–202

    Article  CAS  Google Scholar 

  69. Shaw MD, Foy PM, Conway M, et al (1985) Dipyridamole and postoperative ischemic deficits in aneurysmal subarachnoid hemorrhage. J Neurosurg 63:699–703

    CAS  PubMed  Google Scholar 

  70. Saito I, Asano T, Ochiai C, Takakura K, Tamura A, Sano K (1983) A double-blind clinical evaluation of the effect of Nizofenone (Y-9179) on delayed ischemic neurological deficits following aneurysmal rupture. Neurol Res 5:29–47

    CAS  PubMed  Google Scholar 

  71. Tokiyoshi K, Ohnishi T, Nii Y (1991) Efficacy and toxicity of thromboxane synthetase inhibitor for cerebral vasospasm after subarachnoid hemorrhage. Surg Neurol 36:112–118

    Article  CAS  PubMed  Google Scholar 

  72. Suzuki S, Sano K, Handa H, et al (1989) Clinical study of OKY-046, a thromboxane synthetase inhibitor, in prevention of cerebral vasospasms and delayed cerebral ischemic symptoms after subarachnoid hemorrhage due to aneurysmal rupture: a randomized, double-blind study. Neurol Res 11:79–88

    CAS  PubMed  Google Scholar 

  73. Veyna RS, Seyfried D, Burke D, et al (2002) Magnesium sulfate therapy for aneurysmal subarachnoid hemorrhage. J Neurosurg 96:510–514

    CAS  PubMed  Google Scholar 

  74. Egge A, Waterloo K, Sjoholm H, Solberg T, Ingebrigten T, Romner B (2001) Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal subarachnoid hemorrhage: a clinical, prospective, randomized, controlled study. Neurosurgery 49:593–606

    Article  CAS  PubMed  Google Scholar 

  75. Lennihan L, Mayer SA, Fink ME, et al (2000) Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: a randomized controlled trial. Stroke 2000;31:383–391

    Google Scholar 

  76. Mayer SA, Solomon RA, Fink ME, et al (1998) Effect of 5% albumin solution on sodium balance and blood volume after subarachnoid hemorrhage. Neurosurgery 42:759–768

    Article  CAS  PubMed  Google Scholar 

  77. Nakagawa A, Su CC, Sato K, Shirane R (2002) Evaluation of changes in circulating blood volume during acute and very acute stages of subarachnoid hemorrhage: implications for the management of hypovolemia. J Neurosurg 97:268–271

    PubMed  Google Scholar 

  78. Muizelaar JP, Zwienenberg M, Rudisill NA, Hecht ST (1999) The prophylactic use of transluminal balloon angioplasty in patients with Fischer grade 3 subarachnoid hemorrhage: a pilot. J Neurosurg 91:51–58

    CAS  PubMed  Google Scholar 

  79. Suarez JI, Shannon L, Zaidat OO, et al (2004) Effect of human albumin administration on clinical outcome and hospital cost in patients with SAH. J Neurosurg 100:585–90

    CAS  PubMed  Google Scholar 

  80. Treatment of subarachnoid hemorrhage with human albumin. NCT 00283400. At: http://www.clini-caltrials.gov. Accessed Dec 2006

  81. Guglielmi G, Vinuela F, Dion J, Duckweiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75: 8–14

    CAS  PubMed  Google Scholar 

  82. Molyneux A, Kerr R, Stratton I, et al (2002) International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  83. Molyneux AJ, Kerr RSC, Yu LM, et al (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817

    Article  PubMed  Google Scholar 

  84. Britz GW (2005) ISAT Trial: coiling or clipping for intracranial aneurysms?. Lancet 366:783–785

    Article  PubMed  Google Scholar 

  85. Johnston CS, Higashida RT, Barrow DL, et al (2002) Recommendations for the endovascular treatment of intracranaila aneurysms. A Statement for Healthcare Professionals fro the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke 33:2536–2544

    Article  PubMed  Google Scholar 

  86. Lozier AP, Connolly ES Jr, Lavine SD, Solomon RA (2002) Guglielmi detachable coil emboli-zation of posterior circulation aneurysms. A systematic review of the literature. Stroke 33:2509–2518

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    J. I. Suarez

Authors
  1. J. I. Suarez
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070, Brussels, Belgium

    Jean-Louis Vincent MD, PhD, FCCM, FCCP (Head) (Head)

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Science + Business Media Inc.

About this paper

Cite this paper

Suarez, J.I. (2007). Non-traumatic Subarachnoid Hemorrhage. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-49518-7_64

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-49518-7_64

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-49517-0

  • Online ISBN: 978-0-387-49518-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation