MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE IN AN INTENSIVE-CARE UNIT AS PART OF A COORDINATED STROKE CONCEPT - FIRST EXPERIENCE

Questions under study: It has been shown that the prognosis of patient s with stroke can be improved by specialized stroke units. Whether any additional benefit can be achieved by use of intensive care resources is unknown. Therefore, it was the purpose of this study to analyze ou r first experience of management of patients with acute ischaemic stro ke in an intensive care unit, as part of a newly implemented coordinat ed stroke concept. Methods: A consecutive series of 88 patients with a cute ischemic stroke (age 64.4 +/- 14.2 years, 28% females) hospitaliz ed in a medical intensive care unit according to predefined criteria f ormed the study population. The goals were to monitor vital functions, to complete diagnostic studies in timely fashion and to prevent and t reat complications. Results: The patients were hospitalized in the int ensive care unit for a mean period of 34.4 +/- 19.5 hours. Relevant pa thologic findings included systolic hypertension >220 mm Hg in 5% and permanent or intermittent relative systolic hypotension <150 mm Hg in 25% and 98% of patients respectively. One patient (1%) died during the stay. Additional diagnostic studies were performed more often in pati ents with progressive or fluctuating symptoms (100% of patients in eac h group) than in those with improving or stable symptoms (50% of patie nts in each group). Fourteen percent of patients were treated for hype rtension and 30% for hypotension. Antithrombotic therapy with aspirin was started in 34%, prophylaxis for venous thrombosis with low dose he parin in 39% and systemic anticoagulation in 40% of patients respectiv ely. No cardiac or pulmonary complications requiring treatment were ob served and no specific therapies for neurologic complications were uti lized. At the time of discharge from the intensive care unit, 88% of p atients showed improved or stable neurologic findings. Conclusions: In the present analysis, an unexpectedly high incidence of relative arte rial hypotension was observed in patients hospitalized in an intensive care unit for acute ischaemic stroke. Therapeutic measures were restr icted mainly to blood pressure control and anticoagulation/antithrombo tic treatment. Specific therapies for neurologic complications or inte rventions requiring the resources of an intensive care unit were not u sed. Whether defined patient groups with ischaemic stroke will benefit from specific treatment in an intensive care unit needs to be tested by controlled, randomized studies.