[Stroke care in the ICU: general supportive treatment. Experts' recommendations].
The French Society of Intensive Care (SRLF) requested medical experts to publish recommendations on the management of stroke in the ICU for adult and pediatric patients. The following article describes the underlying evidence used by the experts to elaborate recommendations for general supportive treatment. Such treatment is fundamental for victims of acute stroke to avoid neurological worsening. Oxygen delivery in a normoxic patient is useless. However, if saturation is below 92 %, oxygen supplementation is needed. Hyper- and hypoglycemia worsen the neurological prognosis. As no glycemic target is known, administration of insulin is required for glucose levels higher that 10 mmol/l. Body temperature above 37.5° is associated with poorer outcome. In the acute phase of stroke, high blood pressure should not be lowered except in life-threatening situations, and if so the lowering should be done cautiously. The current consensus is to lower blood pressure if the systolic pressure is above 220 mmHg or if the diastolic pressure is above 120 mmHg for ischemic stroke. For hemorrhagic stroke and after thrombolysis, treatment is needed if systolic pressure rises above 180 mmHg and if diastolic pressure is above 105 mmHg. Small doses of heparin decrease the risk of deep venous thrombosis and pulmonary embolism without increasing cerebral bleeding. There is no consensus on the treatment of epileptic crises after stroke and no dedicated treatment. Further studies are needed to define adequate blood pressure and glycemic target values in order to limit secondary worsening after an acute stroke as well as the appropriate modalities for the treatment of epilepsy.
Service des soins intensifs adultes, hôpitaux universitaires de Genève, 4 rue Gabrielle-Perret-Gentil, Geneva, Switzerland. deborah.pugin@hcuge.ch
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D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology; D001786:Blood Glucose; D001794:Blood Pressure / Q000502:physiology; D001831:Body Temperature; D002648:Child; D003422:Critical Care / Q000379:methods*; D004827:Epilepsy / Q000209:etiology; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000627:therapeutic use; D020521:Stroke / Q000150:complications / Q000628:therapy*; D054556:Venous Thromboembolism / Q000517:prevention & control
D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010100:Oxygen