Evidence Summary for blood pressure management in patients with ruptured intracranial aneurysms: Implications for clinical nursing practice

Background and objectives

Given that hemodynamic fluctuations acutely escalate the risk of devastating rebleeding and secondary neurological deficits in unsecured ruptured intracranial aneurysms, this study aimed to synthesize the best available evidence for blood pressure management in this population and to provide an evidence-based foundation for clinical nursing practice.

Methods

A systematic search was conducted in domestic and international databases and relevant websites for evidence pertaining to blood pressure management in patients with ruptured intracranial aneurysms, including clinical practices, guidelines, expert consensuses, evidence summaries, and systematic reviews/meta-analyses. The search period covered database inception up to June 2025. Two researchers independently performed literature quality assessments and evidence extraction, with particular attention to nursing-relevant evidence on hemodynamic monitoring, bedside assessment, complication prevention, fluid management, and follow-up coordination.

Results

A total of 17 studies were included, comprising 11 guidelines, 4 expert consensuses, and 2 clinical decision entries. The synthesized evidence yielded 32 recommendations, structured into 6 core clinical domains: personnel and environmental configuration, individualized blood pressure targeting, precision hemodynamic monitoring, complication prevention, fluid therapy strategy, and longitudinal follow-up protocols. These recommendations further clarified key nursing responsibilities in triage coordination, continuous blood pressure surveillance, neurological assessment, delayed cerebral ischemia surveillance, fluid balance monitoring, and long-term follow-up.

Conclusion

This study systematically synthesized 32 items of best evidence to establish a structured, high-density framework for optimizing periprocedural blood pressure management in patients with ruptured IAs. The resulting evidence matrix is broadly aligned with six core clinical domains: establishing multidisciplinary networks, calibrating individualized blood pressure targets, ensuring precision hemodynamic monitoring, executing targeted complication prevention, structuring fluid therapy strategies, and scheduling longitudinal follow-up. Furthermore, this framework helps operationalize the specialized roles of neurocritical care nurses in active clinical triage, real-time arterial tracking, proactive delayed cerebral ischemia surveillance, and long-term surveillance. These synthesized findings provide an evidence-based framework to guide standardized nursing-led blood pressure management protocols, offering an actionable pathway to mitigate rebleeding risks and improve clinical outcomes in this high-acuity patient population.

Full text:

https://www.xiahepublishing.com/3067-6150/NSSS-2026-00007

The study was recently published in the Neurosurgical Subspecialties.

Neurosurgical Subspecialties (NSSS) is the official scientific journal of the Department of Neurosurgery at Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. NSSS aims to provide a forum for clinicians and scientists in the field, dedicated to publishing high-quality and peer-reviewed original research, reviews, opinions, commentaries, case reports, and letters across all neurosurgical subspecialties. These include but are not limited to traumatic brain injury, spinal and spinal cord neurosurgery, cerebrovascular disease, stereotactic radiosurgery, neuro-oncology, neurocritical care, neurosurgical nursing, neuroendoscopy, pediatric neurosurgery, peripheral neuropathy, and functional neurosurgery.

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