title: Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting.
abstract: OBJECTIVE
  Patients with acute brain injuries require strict physiologic control to minimize morbidity and mortality. This study aimed to assess in-hospital compliance to strict physiologic parameters (BP, HR, ICP, SpO2) in these populations.
  
  
  METHODS
  Patients with severe cerebrovascular events were admitted to the neurointensive care unit (NSICU) and were continuously monitored using the BedMasterEX (Excel Medical Electronics Inc, FL) system, which recorded hemodynamic data via an arterial catheter continuously in 5-s intervals. Furthermore, we investigated the impact of healthcare provider shift changes (6-8 a.m./p.m) and of day (6 a.m.-6 p.m.) versus night (6 p.m-6 a.m) shifts in hemodynamic control.
  
  
  RESULTS
  Fifty patients admitted to the NSICU, 50 % male, mean age 59.7 ± 13.9 years with subarachnoid hemorrhage (23), ischemic stroke (8), subdural hematoma (4), intracerebral hemorrhage (3), intraventricular hemorrhage (2), and miscellaneous injuries (10) were enrolled. Data represented 2,337 total hours of continuous monitoring. Systolic BPs (SBP) were on average outside of recommended ranges 32.26 ± 30.46 % of the monitoring period. We subdivided adherence to ideal SBP range: optimal (≥99 % of time spent in NSICU within range) was achieved in 12 %, adequate (90 %) in 16 %, suboptimal (80 %) in 20 %, inadequate I (70 %) in 12 %, and inadequate II (<70 %) in 40 % of patients. Comparison of shift change %time and day versus night %time out of parameter yielded no statistically significant differences across SAH patients.
  
  
  CONCLUSIONS
  Hemodynamic management of patients with cerebrovascular injuries, based on targeted thresholds in the NSICU, yielded optimal control of SBP in only 28 % of our patients (within parameters ≥90 % of time).
authors.affiliation: College of Medicine, MUSC, Charleston, SC, USA.
authors.forename: Guilherme B F
authors.initials: GB
authors.lastname: Porto
authors.affiliation: Department of Neurosciences, MUSC, Charleston, SC, USA.
authors.forename: Alejandro M
authors.initials: AM
authors.lastname: Spiotta
authors.affiliation: Department of Neurosciences, MUSC, Charleston, SC, USA.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chalela
authors.affiliation: Department of Neurosciences, MUSC, Charleston, SC, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Kellogg
authors.affiliation: Department of Neurosciences, MUSC, Charleston, SC, USA. jauch@musc.edu.|Department of Emergency Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 210, Charleston, SC, 29425, USA. jauch@musc.edu.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units; D020300:Intracranial Hemorrhages / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*
keywords: Acute brain injury; Compliance; Hemodynamic management; Neurocritical care; Physiologic parameters; Subarachnoid hemorrhage (SAH); Systolic blood pressure (SBP) parameter adherence