The intensive care management of acute ischemic stroke

被引:6
作者
Deibert, E [1 ]
Diringer, MN [1 ]
机构
[1] Washington Univ, Sch Med, Dept Neurol, Intens Care Unit, St Louis, MO 63110 USA
关键词
thrombolysis; basilar artery thrombosis; cerebellum; hemispheric stroke; mechanical ventilation; cardiac arrhythmias;
D O I
10.1097/00127893-199911000-00003
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKCROUND- Therapy for acute ischemic stroke is rapidly evolving. The introduction of the use of thrombolytics along with an increased physician and community awareness of stroke has created a demand for earlier and more aggressive interventions. As a result, there is increased interest in meeting the unique cardiovascular, pulmonary, and neurologic needs of these patients in specialized intensive care and stroke units. REVIEW SUMMARY- This article will review indications for admission of ischemic stroke patients to an intensive care or-stroke unit; airway, respiratory, and cardiovascular management; thrombolytic therapy; and general medical issues such as nutrition, temperature management, deep venous thrombosis prophylaxis, and control of blood glucose. In addition, specific management issues for patients with large hemispheric stroke, cerebellar stroke, and basilar artery thrombosis will be reviewed. CONCLUSIONS- Stroke units and intensive care units with specially trained neurologic intensivists are becoming increasingly involved in the initial management of patients with acute ischemic stroke. The main non-neurologic indica indications for admission to these units are airway management and:cardiovascular monitoring. In addition, new therapies such-as the use of intravenous and intra-arterial thrombolytics and decompressive craniectomy have increased the need for close neurologic and hemodynamic monitoring in specialized units.
引用
收藏
页码:313 / 325
页数:13
相关论文
共 109 条
[1]  
Adams HP, 1996, STROKE, V27, P1711
[2]  
Adams HP, 1996, NEUROLOGY, V47, P835
[3]   GUIDELINES FOR THE MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE - A STATEMENT FOR HEALTH-CARE PROFESSIONALS FROM A SPECIAL WRITING GROUP OF THE STROKE COUNCIL, AMERICAN-HEART-ASSOCIATION [J].
ADAMS, HP ;
BROTT, TG ;
CROWELL, RM ;
FURLAN, AJ ;
GOMEZ, CR ;
GROTTA, J ;
HELGASON, CM ;
MARLER, JR ;
WOOLSON, RF ;
ZIVIN, JA ;
FEINBERG, W ;
MAYBERG, M .
CIRCULATION, 1994, 90 (03) :1588-1601
[4]   Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke - An interhospital comparison [J].
Addington, WR ;
Stephens, RE ;
Gilliland, KA .
STROKE, 1999, 30 (06) :1203-1207
[5]   THE SPECTRUM OF CEREBELLAR INFARCTIONS [J].
AMARENCO, P .
NEUROLOGY, 1991, 41 (07) :973-979
[6]  
[Anonymous], 1998, The ICU Book
[7]   BASILAR ARTERY-OCCLUSION - CLINICAL AND RADIOLOGICAL CORRELATION [J].
ARCHER, CR ;
HORENSTEIN, S .
STROKE, 1977, 8 (03) :383-390
[8]   FEVER IN ACUTE STROKE WORSENS PROGNOSIS - A PROSPECTIVE-STUDY [J].
AZZIMONDI, G ;
BASSEIN, L ;
NONINO, F ;
FIORANI, L ;
VIGNATELLI, L ;
RE, G ;
DALESSANDRO, R .
STROKE, 1995, 26 (11) :2040-2043
[9]   Causes and mechanisms of cerebellar infarction in young patients [J].
Barinagarrementeria, F ;
Amaya, LE ;
Cantu, C .
STROKE, 1997, 28 (12) :2400-2404
[10]   Community-acquired pneumonia in adults: Guidelines for management [J].
Bartlett, JG ;
Breiman, RF ;
Mandell, LA ;
File, TM .
CLINICAL INFECTIOUS DISEASES, 1998, 26 (04) :811-838