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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2014; 01(02): 101-107
DOI: 10.4103/2348-0548.130383
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Systemic care in the acute management of patients with stroke

Kamath Sriganesh
1   Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
,
M. Radhakrishnan
1   Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
,
Ganne S. Umamaheswara Rao
1   Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
› Author Affiliations
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Publication History

Publication Date:
28 April 2018 (online)

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Abstract

Early and effective systemic management plays an important role in the outcome of patients with stroke. Vigilant respiratory and hemodynamic monitoring and optimisation along with nutritional and metabolic correction goes a long way in improving results of definitive treatment in patients with stroke. This review discusses the systemic changes occurring after stroke and provides current evidence in the management of these factors, which significantly influence the outcome.

Keywords

Cerebral oxygenation - intensive care - intracerebral haematoma - ischemia - stroke
 

  • REFERENCES

  • 1 Summers D, Leonard A, Wentworth D, Saver JL, Simpson J, Spilker JA. et al. American Heart Association Council on Cardiovascular Nursing and the Stroke Council. Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient: A scientific statement from the American Heart Association. Stroke 2009; 40: 2911-44
    CrossrefPubMedGoogle Scholar
  • 2 Bershad EM, Feen ES, Hernandez OH, Suri MF, Suarez JI. Impact of a specialized neurointensive care team on outcomes of critically ill acute ischemic stroke patients. Neurocrit Care 2008; 9: 287-92
    CrossrefPubMedGoogle Scholar
  • 3 Hilker R, Poetter C, Findeisen N, Sobesky J, Jacobs A, Neveling M. et al. Nosocomial pneumonia after acute stroke implications for neurological intensive care medicine. Stroke 2003; 34: 975-81
    CrossrefPubMedGoogle Scholar
  • 4 Adams HP, Zoppo GD, Alberts MJ, Bhatt DL, Brass L, Furlan A. et al. Guidelines for the early management of adults with ischemic stroke. Stroke 2007; 38: 1655-711
    CrossrefPubMedGoogle Scholar
  • 5 Grotta J, Pasteur W, Khwaja G, Hamel T, Fisher M, Ramirez A. Elective intubation for neurologic deterioration after stroke. Neurology 1995; 45: 640-4
    CrossrefPubMedGoogle Scholar
  • 6 Gujjar AR, Deibert E, Manno EM, Duff S, Diringer MN. Mechanical ventilation for ischemic stroke and intracerebral hemorrhage: Indications, timing, and outcome. Neurology 1998; 51: 447-51
    CrossrefPubMedGoogle Scholar
  • 7 Georgiadis D, Schwarz S, Baumgartner RW, Veltkamp R, Schwab S. Influence of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure in patients with acute stroke. Stroke 2001; 32: 2088-92
    CrossrefPubMedGoogle Scholar
  • 8 Eames PJ, Blake MJ, Dawson SL, Panerai RB, Potter JF. Dynamic cerebral autoregulation and beat to beat blood pressure control are impaired in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2002; 72: 467-72
    PubMedGoogle Scholar
  • 9 Leonardi-Bee J, Bath PM, Phillips SJ, Sandercock PA. IST Collaborative Group. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke 2002; 33: 1315-20
    CrossrefPubMedGoogle Scholar
  • 10 Potter J, Robinson T, Ford G, James M, Jenkins D, Mistri A. et al. CHHIPS Trial Group. CHHIPS (Controlling Hypertension and Hypotension Immediately Post-Stroke) pilot trial: Rationale and design. J Hypertens 2005; 23: 649-55
    CrossrefPubMedGoogle Scholar
  • 11 Zhang Y, Reilly KH, Tong W, Xu T, Chen J, Bazzano LA. et al. Blood pressure and clinical outcome among patients with acute stroke in Inner Mongolia, China. J Hypertens 2008; 26: 1446-52
    CrossrefPubMedGoogle Scholar
  • 12 Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral hemorrhage: Relationship between elevated blood pressure and hematoma enlargement. Stroke 2004; 35: 1364-7
    CrossrefPubMedGoogle Scholar
  • 13 Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D. et al. American Heart Association, American Stroke Association Stroke Council, High Blood Pressure Research Council, Quality of Care and Outcomes in Research Interdisciplinary Working Group. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: A guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 2007; 38: 2001-23
    CrossrefPubMedGoogle Scholar
  • 14 Hocker S, Morales-Vidal S, Schneck MJ. Management of arterial blood pressure in acute ischemic and hemorrhagic stroke. Neurol Clin 2010; 28: 863-86
    CrossrefPubMedGoogle Scholar
  • 15 Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B. et al. Intensive blood pressure reduction in acute cerebral hemorrhage trial (INTERACT). A randomized pilot trial. Lancet Neurol 2008; 7: 391-9
    CrossrefPubMedGoogle Scholar
  • 16 Morgenstern LB, Hemphill 3rd JC, Anderson C, Becker K, Broderick JP, Connolly Jr ES. et al. American Heart Association Stroke Council and Council on Cardiovascular Nursing. Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke 2010; 41: 2108-29
    CrossrefPubMedGoogle Scholar
  • 17 Aiyagari V, Gorelick PB. Management of blood pressure for acute and recurrent stroke. Stroke 2009; 40: 2251-6
    CrossrefPubMedGoogle Scholar
  • 18 Reith J, Jorgensen HS, Pedersen PM, Nakayama H, Raaschou HO, Jeppesen LL. et al. Body temperature in acute stroke: Relation to stroke severity, infarct size, mortality, and outcome. Lancet 1996; 347: 422-5
    CrossrefPubMedGoogle Scholar
  • 19 Yenari MA, Hemmen TM. Therapeutic hypothermia for brain ischemia: Where have we come and where do we go?. Stroke 2010; 41: S72-4
    CrossrefPubMedGoogle Scholar
  • 20 Williams LS, Rotich J, Qi R, Fineberg N, Espay A, Bruno A. et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology 2002; 59: 67-71
    CrossrefPubMedGoogle Scholar
  • 21 Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in non-diabetic and diabetic patients: A systematic overview. Stroke 2001; 32: 2426-32
    CrossrefPubMedGoogle Scholar
  • 22 Gray CS, Hildreth AJ, Sandercock PA, O'Connell JE, Johnston DE, Cartlidge NE. et al. GIST Trialists Collaboration. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycemia: The UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol 2007; 6: 397-406
    CrossrefPubMedGoogle Scholar
  • 23 McCormick MT, Muir KW, Gray CS, Walters MR. Management of hyperglycemia in acute stroke. How, when, and for whom? Stroke 2008; 39: 2177-85
    PubMedGoogle Scholar
  • 24 Kruyt ND, Biessels GJ, Devries JH, Roos YB. Hyperglycemia in acute ischemic stroke: Pathophysiology and clinical management. Nat Rev Neurol 2010; 6: 145-55
    CrossrefPubMedGoogle Scholar
  • 25 Bhalla A, Sankaralingam S, Dundas R, Swaminathan R, Wolfe CD, Rudd AG. Influence of raised plasma osmolality on clinical outcome after acute stroke. Stroke 2000; 31: 2043-8
    CrossrefPubMedGoogle Scholar
  • 26 Rodrigues B, Staff I, Fortunato G, McCullough LD. Hyponatremia in the Prognosis of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2013. pii: S1052-3057(13)00277-2. [Epub ahead of print] DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.011
    CrossrefGoogle Scholar
  • 27 Helbok R, Kurtz P, Schmidt JM, Stuart RM, Fernandez L, Malhotra R. et al. Effect of mannitol on brain metabolism and tissue oxygenation in severe hemorrhagic stroke. J Neurol Neurosurg Psychiatry 2011; 82: 378-83
    CrossrefPubMedGoogle Scholar
  • 28 Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 1998; 29: 1550-5
    CrossrefPubMedGoogle Scholar
  • 29 Toung TJ, Chang Y, Lin J, Bharadwaj A. Increases in lung and brain water following experimental stroke: Effect of mannitol and hypertonic saline. Crit Care Med 2005; 33: 203-8
    CrossrefPubMedGoogle Scholar
  • 30 Farquhar WB, Paul EE, Prettyman AV, Stillabower MA. Blood pressure and hemodynamic responses to an acute sodium load in humans. J Appl Physiol (1985) 2005; 99: 1545-51
    CrossrefPubMedGoogle Scholar
  • 31 CLOTS Trials Collaboration. Dennis M, Sandercock PA, Reid J, Graham C, Murray G, Venables G. et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): A multicentre randomized controlled trial. Lancet 2009; 373: 1958-65
    CrossrefPubMedGoogle Scholar
  • 32 CLOTS (Clots in Legs or sTockings after Stroke) Trial Collaboration. Thigh-length versus below-knee stockings for deep venous thrombosis prophylaxis after stroke: A randomized trial. Ann Intern Med 2010; 153: 553-62
    CrossrefPubMedGoogle Scholar
  • 33 Kikuchi K, Kawahara KI, Miura N, Ito T, Morimoto Y, Tancharoen S. et al. Secondary prevention of stroke: Pleiotropic effects of optimal oral pharmacotherapy. Exp Ther Med 2012; 4: 3-7
    CrossrefPubMedGoogle Scholar
  • 34 Higgins P, Macfarlane PW, Dawson J, McInnes GT, Langhorne P, Lees KR. Noninvasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: A randomized, controlled trial. Stroke 2013; 44: 2525-31
    CrossrefPubMedGoogle Scholar
  • 35 Idicula TT, Waje-Andreassen U, Brogger J, Naess H, Lundstadsveen MT, Thomassen L. The effect of physiologic derangement in patients with stroke treated with thrombolysis. J Stroke Cerebrovasc Dis 2008; 17: 141-6
    CrossrefPubMedGoogle Scholar
  • 36 Cavallini A, Micieli G, Marcheselli S, Quaglini S. Role of monitoring in management of acute ischemic stroke patients. Stroke 2003; 34: 2599-603
    CrossrefPubMedGoogle Scholar
  • 37 Aaron S, Alexander M, Maya T, Mathew V, Goyal M. Treatment of acute ischemic stroke: awareness among general practitioners. Neurol India 2010; 58: 441-2
    CrossrefPubMedGoogle Scholar
  • 38 Srivastva MV. Mechanical thrombectomy for acute ischemic stroke: The road thus far. Neurol India 2012; 60: 395-9
    CrossrefPubMedGoogle Scholar
  • 39 Sharma SR, Sharma N. Hyperacute thrombolysis with recombinant tissue plasminogen activator of acute ischemic stroke: Feasibility and effectivity from an Indian perspective. Ann Indian Acad Neurol 2008; 11: 221-4
    CrossrefPubMedGoogle Scholar