Management of patients with acute ischaemic 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 patients 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 our first experience of management of patients with acute ischaemic stroke in an intensive care unit, as part of a newly implemented coordinated stroke concept. Methods: A consecutive series of 88 patients with acute ischemic stroke (age 64.4 +/- 14.2 years, 28% females) hospitalized in a medical intensive care unit according to predefined criteria formed the study population. The goals were to monitor vital functions, to complete diagnostic studies in timely fashion and to prevent and treat complications. Results: The patients were hospitalized in the intensive care unit for a mean period of 34.4 +/- 19.5 hours. Relevant pathologic 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 patients with progressive or fluctuating symptoms (100% of patients in each group) than in those with improving or stable symptoms (50% of patients in each group). Fourteen percent of patients were treated for hypertension and 30% for hypotension. Antithrombotic therapy with aspirin was started in 34%, prophylaxis for venous thrombosis with low dose heparin in 39% and systemic anticoagulation in 40% of patients respectively. No cardiac or pulmonary complications requiring treatment were observed and no specific therapies for neurologic complications were utilized. At the time of discharge from the intensive care unit, 88% of patients showed improved or stable neurologic findings. Conclusions: In the present analysis, an unexpectedly high incidence of relative arterial hypotension was observed in patients hospitalized in an intensive care unit for acute ischaemic stroke. Therapeutic measures were restricted mainly to blood pressure control and anticoagulation/antithrombotic treatment. Specific therapies for neurologic complications or interventions requiring the resources of an intensive care unit were not used. 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.