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Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting

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Abstract

Background and Purpose

Patients with acute brain injuries require strict physiologic control to minimize morbidity and mortality. This study aimed to assess in-hospital compliance to strict physiologic parameters (BP, HR, ICP, SpO2) in these populations.

Methods

Patients with severe cerebrovascular events were admitted to the neurointensive care unit (NSICU) and were continuously monitored using the BedMasterEX (Excel Medical Electronics Inc, FL) system, which recorded hemodynamic data via an arterial catheter continuously in 5-s intervals. Furthermore, we investigated the impact of healthcare provider shift changes (6–8 a.m./p.m) and of day (6 a.m.–6 p.m.) versus night (6 p.m–6 a.m) shifts in hemodynamic control.

Results

Fifty patients admitted to the NSICU, 50 % male, mean age 59.7 ± 13.9 years with subarachnoid hemorrhage (23), ischemic stroke (8), subdural hematoma (4), intracerebral hemorrhage (3), intraventricular hemorrhage (2), and miscellaneous injuries (10) were enrolled. Data represented 2,337 total hours of continuous monitoring. Systolic BPs (SBP) were on average outside of recommended ranges 32.26 ± 30.46 % of the monitoring period. We subdivided adherence to ideal SBP range: optimal (≥99 % of time spent in NSICU within range) was achieved in 12 %, adequate (90 %) in 16 %, suboptimal (80 %) in 20 %, inadequate I (70 %) in 12 %, and inadequate II (<70 %) in 40 % of patients. Comparison of shift change %time and day versus night %time out of parameter yielded no statistically significant differences across SAH patients.

Conclusion

Hemodynamic management of patients with cerebrovascular injuries, based on targeted thresholds in the NSICU, yielded optimal control of SBP in only 28 % of our patients (within parameters ≥90 % of time).

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References

  1. Leira R, et al. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology. 2004;63(3):461–7.

    Article  CAS  PubMed  Google Scholar 

  2. Jeffs L, et al. Patients’ views on bedside nursing handover: creating a space to connect. J Nurs Care Qual. 2014;29(2):149–54.

    Article  PubMed  Google Scholar 

  3. Albright KC, et al. Can comprehensive stroke centers erase the ‘weekend effect’? Cerebrovasc Dis. 2009;27(2):107–13.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Juul N, et al. Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg. 2000;92(1):1–6.

    Article  CAS  PubMed  Google Scholar 

  5. Spiotta AM, et al. Brain tissue oxygen-directed management and outcome in patients with severe traumatic brain injury. J Neurosurg. 2010;113(3):571–80.

    Article  PubMed  Google Scholar 

  6. Steiner LA, et al. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002;30(4):733–8.

    Article  PubMed  Google Scholar 

  7. Manley G, et al. Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg. 2001;136(10):1118–23.

    Article  CAS  PubMed  Google Scholar 

  8. Sheth KN, Sims JR. Neurocritical care and periprocedural blood pressure management in acute stroke. Neurology. 2012;79(13 Suppl 1):S199–204.

    Article  PubMed  Google Scholar 

  9. Fujii Y, et al. Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage. Stroke. 1998;29(6):1160–6.

    Article  CAS  PubMed  Google Scholar 

  10. Dandapani BK, et al. Relation between blood pressure and outcome in intracerebral hemorrhage. Stroke. 1995;26(1):21–4.

    Article  CAS  PubMed  Google Scholar 

  11. Jauch EC, et al. Lack of evidence for an association between hemodynamic variables and hematoma growth in spontaneous intracerebral hemorrhage. Stroke. 2006;37(8):2061–5.

    Article  PubMed  Google Scholar 

  12. Tymianski M. Novel approaches to neuroprotection trials in acute ischemic stroke. Stroke. 2013;44(10):2942–50.

    Article  PubMed  Google Scholar 

  13. Group I.S.T.c., et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379(9834):2352–63.

    Article  Google Scholar 

  14. Fisher M. The ischemic penumbra: a new opportunity for neuroprotection. Cerebrovasc Dis. 2006;21(Suppl 2):64–70.

    Article  PubMed  Google Scholar 

  15. Del Zoppo GJ, et al. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke. 2009;40(8):2945–8.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Sacchetti ML. Is it time to definitely abandon neuroprotection in acute ischemic stroke? Stroke. 2008;39(6):1659–60.

    Article  PubMed  Google Scholar 

  17. Clark WM, et al. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS study: a randomized controlled trial. Alteplase thrombolysis for acute noninterventional therapy in ischemic stroke. JAMA. 1999;282(21):2019–26.

    Article  CAS  PubMed  Google Scholar 

  18. Adams HP Jr, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38(5):1655–711.

    Article  PubMed  Google Scholar 

  19. Jauch EC, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.

    Article  PubMed  Google Scholar 

  20. European Stroke Initiative Writing, Cognard C, et al. Recommendations for the management of intracranial haemorrhage—part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis. 2006;22(4):294–316.

    Article  Google Scholar 

  21. Connolly ES Jr, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012;43(6):1711–37.

    Article  PubMed  Google Scholar 

  22. Robertson CS. Management of cerebral perfusion pressure after traumatic brain injury. Anesthesiology. 2001;95(6):1513–7.

    Article  CAS  PubMed  Google Scholar 

  23. Muroi C, et al. Novel treatments for vasospasm after subarachnoid hemorrhage. Curr Opin Crit Care. 2012;18(2):119–26.

    Article  PubMed  Google Scholar 

  24. van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007;369(9558):306–18.

    Article  PubMed  Google Scholar 

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Acknowledgments

Financial Support: NIH Student Training Grant 5T35DK007431-29 MUSC Emergency Medicine, Neurosciences and Neurosurgery Departments.

Conflict of interest

Guilherme Porto, Alejandro Spiotta, Julio Chalela, Ryan Kellogg, and Edward Jauch declare that they have no interest of conflict.

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Authors and Affiliations

  1. College of Medicine, MUSC, Charleston, SC, USA

    Guilherme B. F. Porto

  2. Department of Neurosciences, MUSC, Charleston, SC, USA

    Alejandro M. Spiotta, Julio A. Chalela, Ryan T. Kellogg & Edward C. Jauch

  3. Department of Emergency Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 210, Charleston, SC, 29425, USA

    Edward C. Jauch

Authors
  1. Guilherme B. F. Porto
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  2. Alejandro M. Spiotta
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  3. Julio A. Chalela
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  4. Ryan T. Kellogg
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  5. Edward C. Jauch
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Corresponding author

Correspondence to Edward C. Jauch.

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Porto, G.B.F., Spiotta, A.M., Chalela, J.A. et al. Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting. Neurocrit Care 23, 313–320 (2015). https://doi.org/10.1007/s12028-015-0116-y

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  • DOI: https://doi.org/10.1007/s12028-015-0116-y

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