急性缺血性中风患者的重症监护入院和管理：欧洲重症监护医学会的横断面调查

急性缺血性中风患者的重症监护入院和管理：欧洲重症监护医学会的横断面调查



摘要

背景：关于危重病急性缺血性中风（AIS）患者的重症监护治疗，目前尚无具体的建议，关于该人群的最佳通气、血流动力学和普通重症监护室（ICU）治疗目标仍存在问题。我们进行了一项国际调查，以调查AIS患者的ICU入院标准和管理。


方法：2019年11月1日至2020年3月30日期间，欧洲重症监护医学会网站上提供了一份电子问卷，包括25个项目，分为3个部分，并通过神经重症监护（NIC）部分时事通讯进行宣传。这项调查通过电子邮件直接发送给NIC成员，并得到了欧洲重症监护医学会的认可。


结果：198个中心共有214名被调查者，应答率为16.5%（214/1296）。在大多数中心（67%），2019年入住受访医院的AIS患者人数在100至300人之间，其中每家医院需要入住ICU的患者不到50人。最广泛接受的ICU入院标准指征是插管和机械通气。88（58%）的受访者使用了动脉血压（ABP）管理的标准方案。对于符合静脉溶栓条件的患者，最常见的ABP靶点是<185/110 mm Hg（n=77[51%]），而对于接受机械血栓切除术的患者，ABP靶点是≤160/90 mm Hg（n=79[54%]）。降低ABP的首选药物是拉贝洛尔（n=84[55.6%]）。其他常用的治疗靶点包括：血糖140~180mg/dL（n=65[43%]），大多数机构通过静脉胰岛素输注维持（n=110[72.4%]）；中风发作后2~3天内开始肠内喂养（n=142[93.4%]）；血氧饱和度（SpO2）>95%（n=80[53%]），潮气量为预测体重的6至8 mL/kg（n=135[89%]）。


结论：AIS的ICU管理，包括治疗目标和临床实践策略，在不同的中心有重要差异。我们的研究结果可能有助于确定未来的研究和建立一个关于AIS患者ICU治疗目标的研究议程。J Neurosurg Anesthesiol

. 2021 Feb 9.

 doi: 10.1097/ANA.0000000000000761. Online ahead of print.

Intensive Care Admission and Management of Patients With Acute Ischemic Stroke: A Cross-sectional Survey of the European Society of Intensive Care Medicine

Chiara Robba 1, Martina Giovannini, Geert Meyfroidt, Mathieu van der Jagt, Giuseppe Citerio, Martin Smith, Collaborators

Affiliations expand

• PMID: 33587531

•  

• DOI: 10.1097/ANA.0000000000000761

Abstract

Background: No specific recommendations are available regarding the intensive care management of critically ill acute ischemic stroke (AIS) patients, and questions remain regarding optimal ventilatory, hemodynamic, and general intensive care unit (ICU) therapeutic targets in this population. We performed an international survey to investigate ICU admission criteria and management of AIS patients.

Methods: An electronic questionnaire including 25 items divided into 3 sections was available on the European Society of Intensive Care Medicine Web site between November 1, 2019 and March 30, 2020 and advertised through the neurointensive care (NIC) section newsletter. This survey was emailed directly to the NIC members and was endorsed by the European Society of Intensive Care Medicine.

Results: There were 214 respondents from 198 centers, with response rate of 16.5% of total membership (214/1296). In most centers (67%), the number of AIS patients admitted to respondents' hospitals in 2019 was between 100 and 300, and, among them, fewer than 50 required ICU admission per hospital. The most widely accepted indication for ICU admission criteria was a requirement for intubation and mechanical ventilation. A standard protocol for arterial blood pressure (ABP) management was utilized by 88 (58%) of the respondents. For patients eligible for intravenous thrombolysis, the most common ABP target was <185/110 mm Hg (n=77 [51%]), whereas for patients undergoing mechanical thrombectomy it was ≤160/90 mm Hg (n=79 [54%]). The preferred drug for reducing ABP was labetalol (n=84 [55.6%]). Other frequently used therapeutic targets included: blood glucose 140 to 180 mg/dL (n=65 [43%]) maintained with intravenous insulin infusion in most institutions (n=110 [72.4%]); enteral feeding initiated within 2 to 3 days from stroke onset (n=142 [93.4%]); oxygen saturation (SpO2) >95% (n=80 [53%]), and tidal volume 6 to 8 mL/kg of predicted body weight (n=135 [89%]).

Conclusions: The ICU management of AIS, including therapeutic targets and clinical practice strategies, importantly varies between centers. Our findings may be helpful to define future studies and create a research agenda regarding the ICU therapeutic targets for AIS patients.