Neurology
Ischemic stroke & intracranial hemorrhage
Stroke and intracranial hemorrhage are neurological emergencies frequently encountered in the ICU. Timely recognition and management are crucial to minimize brain injury and improve patient outcomes.
This section covers:
- Acute Ischemic Stroke: Focused on rapid diagnosis, thrombolysis, thrombectomy, and post-stroke care.
- Spontaneous Intracerebral Hemorrhage (ICH): Guidelines on blood pressure control, anticoagulation reversal, and surgical interventions.
- Subarachnoid Hemorrhage (SAH): Aneurysmal SAH management, emphasizing early aneurysm repair, vasospasm prevention, and critical care strategies.
Early neuroimaging, hemodynamic optimization, and neurocritical care support are essential to improve survival and neurological recovery in critically ill patients.
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Acute ischemic stroke
Acute ischemic stroke
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers et al., Stroke (2019)
What’s inside
This article provides the 2019 update to the American Heart Association/American Stroke Association guidelines for the early management of acute ischemic stroke. It includes evidence-based recommendations for rapid assessment, diagnostic work-up, and treatment strategies, focusing on interventions like thrombolysis and thrombectomy.
Why it’s relevant
Acute ischemic stroke is a time-sensitive condition commonly encountered in the ICU. Rapid identification and intervention are crucial for improving patient outcomes. This updated guideline offers essential guidance for healthcare professionals involved in stroke management.
Key focus
- Early assessment and diagnostic approach, including imaging
- Eligibility and timing for thrombolysis and thrombectomy
- Risk stratification and management of complications
- Post-stroke care and rehabilitation
Takeaway
These guidelines provide critical recommendations for ICU professionals managing acute ischemic stroke. For a convenient summary, refer to this resource, which offers a quick reference to key guidelines and recommendations.
Acute ischemic stroke
Management of Acute Ischemic Stroke
Franziska Herpich et al., Critical Care Medicine (2020)
What’s inside
This article discusses the management of acute ischemic stroke in critically ill patients, focusing on rapid assessment, timely interventions, and post-stroke care. It includes recommendations for thrombolysis, thrombectomy, and management of stroke-related complications in the ICU.
Why it’s relevant
Acute ischemic stroke requires urgent care, especially in critically ill patients, to minimize brain injury and improve outcomes. This article provides ICU professionals with practical strategies for managing these time-sensitive cases.
Key focus
- Early assessment and imaging to determine stroke type and severity
- Thrombolysis and thrombectomy: indications, timing, and protocols
- Management of complications like cerebral edema and hemorrhagic transformation
- Post-stroke monitoring and rehabilitation considerations
Takeaway
This article offers essential guidance for ICU professionals managing acute ischemic stroke. Prompt intervention, including thrombolysis and thrombectomy, is key to improving patient outcomes in the critical care setting.
Spontaneous intracerebral hemorrhage
Spontaneous intracerebral hemorrhage
2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association
Steven M. Greenberg et al., Stroke (2022)
What’s inside
This article presents the 2022 guidelines for the management of patients with spontaneous intracerebral hemorrhage (ICH), offering evidence-based recommendations for diagnosis, treatment, and management of complications. The guidelines cover acute care strategies, surgical interventions, and long-term management.
Why it’s relevant
Intracerebral hemorrhage is a life-threatening condition often requiring critical care. These updated guidelines provide essential information for ICU professionals to manage ICH effectively, focusing on early intervention and minimizing secondary brain injury.
Key focus
- Initial assessment and imaging to confirm diagnosis
- Management of blood pressure and reversal of anticoagulation
- Surgical interventions, including hematoma evacuation
- Monitoring for complications like increased intracranial pressure and seizures
- Long-term management and rehabilitation strategies
Takeaway
These guidelines are crucial for ICU professionals managing patients with spontaneous ICH. Early diagnosis and intervention, alongside careful monitoring and management, are key to improving outcomes in these critically ill patients.
Traumatic intracranial hemorrhage
For traumatic intracranial hemorrhage, see here.
Subarachnoid hemorrhage
Aneurysmal subarachnoid hemorrhage
2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association
Brian L. Hoh et al., Stroke (2023)
What’s inside
This article presents the 2023 guidelines for the management of patients with aneurysmal subarachnoid hemorrhage (aSAH), outlining evidence-based strategies for diagnosis, acute management, and long-term care. It covers key interventions like aneurysm repair, managing intracranial pressure, and preventing complications.
Why it’s relevant
Aneurysmal subarachnoid hemorrhage is a critical and often life-threatening condition requiring rapid intervention. These updated guidelines provide ICU professionals with essential information for managing aSAH patients and improving survival and functional outcomes.
Key focus
- Early diagnosis and imaging modalities, including CT and angiography
- Strategies for aneurysm repair: surgical clipping and endovascular coiling
- Management of elevated intracranial pressure and vasospasm
- Prevention and treatment of complications like rebleeding and seizures
- Long-term care and rehabilitation after recovery
Takeaway
These guidelines are vital for ICU professionals handling patients with aSAH, offering comprehensive management strategies to improve patient outcomes through early intervention, surgical management, and vigilant monitoring.