Antonio Messina1,2, Federico Villa3, Giulia Lionetti4, Laura Galarza5, Geert Meyfroidt6, Mathieu van der Jagt7, Xavier Monnet8, Paolo Pelosi9,10, Maurizio Cecconi3,4, Chiara Robba9,10. 1. Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital - IRCCS, Humanitas University, via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. antonio.messina@humanitas.it. 2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. antonio.messina@humanitas.it. 3. Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital - IRCCS, Humanitas University, via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. 4. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. 5. Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain. 6. Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Louvain, Belgium. 7. Department of Intensive Care Adults and Erasmus MC Stroke Center, Erasmus MC - University Medical Center, Rotterdam, The Netherlands. 8. Paris-Saclay University, AP-HP, Medical Intensive Care Unit, Bicêtre Hospital, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS Research Team, Le Kremlin-Bicêtre, France. 9. Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. 10. Department of Surgical Sciences and Integrated Sciences, University of Genoa, Genoa, Italy.
Abstract
BACKGROUND: The optimal hemodynamic targets and management of patients with acute brain injury are not completely elucidated, but recent evidence points to important impact on clinical outcomes. We performed an international survey with the aim to investigate the practice in the hemodynamic targets, monitoring, and management of patients with acute ischemic stroke (AIS), intracranial hemorrhage (ICH) and subarachnoid hemorrhage (SAH). METHODS: This survey was endorsed by the European Society of Intensive Care (ESICM). An electronic questionnaire of 76 questions divided in 4 sections (general information, AIS, ICH, SAH specific questions) was available between January 2022 to March 2022 on the ESICM website. RESULTS: One hundred fifty-four healthcare professionals from 36 different countries and at least 98 different institutions answered the survey. Routine echocardiography is routinely performed in 37% of responders in AIS, 34% in ICH and 38% in SAH. Cardiac output monitoring is used in less than 20% of cases by most of the responders. Cardiovascular complications are the main reason for using advanced hemodynamic monitoring, and norepinephrine is the most common drug used to increase arterial blood pressure. Most responders target fluid balance to neutral (62% in AIS, 59% in ICH,44% in SAH), and normal saline is the most common fluid used. Large variability was observed regarding the blood pressure targets. CONCLUSIONS: Hemodynamic management and treatment in patients with acute brain injury from cerebrovascular diseases vary largely in clinical practice. Further research is required to provide clear guidelines to physicians for the hemodynamic optimization of this group of patients.
BACKGROUND: The optimal hemodynamic targets and management of patients with acute brain injury are not completely elucidated, but recent evidence points to important impact on clinical outcomes. We performed an international survey with the aim to investigate the practice in the hemodynamic targets, monitoring, and management of patients with acute ischemic stroke (AIS), intracranial hemorrhage (ICH) and subarachnoid hemorrhage (SAH). METHODS: This survey was endorsed by the European Society of Intensive Care (ESICM). An electronic questionnaire of 76 questions divided in 4 sections (general information, AIS, ICH, SAH specific questions) was available between January 2022 to March 2022 on the ESICM website. RESULTS: One hundred fifty-four healthcare professionals from 36 different countries and at least 98 different institutions answered the survey. Routine echocardiography is routinely performed in 37% of responders in AIS, 34% in ICH and 38% in SAH. Cardiac output monitoring is used in less than 20% of cases by most of the responders. Cardiovascular complications are the main reason for using advanced hemodynamic monitoring, and norepinephrine is the most common drug used to increase arterial blood pressure. Most responders target fluid balance to neutral (62% in AIS, 59% in ICH,44% in SAH), and normal saline is the most common fluid used. Large variability was observed regarding the blood pressure targets. CONCLUSIONS: Hemodynamic management and treatment in patients with acute brain injury from cerebrovascular diseases vary largely in clinical practice. Further research is required to provide clear guidelines to physicians for the hemodynamic optimization of this group of patients.
Authors: Steven M Greenberg; Wendy C Ziai; Charlotte Cordonnier; Dar Dowlatshahi; Brandon Francis; Joshua N Goldstein; J Claude Hemphill; Ronda Johnson; Kiffon M Keigher; William J Mack; J Mocco; Eileena J Newton; Ilana M Ruff; Lauren H Sansing; Sam Schulman; Magdy H Selim; Kevin N Sheth; Nikola Sprigg; Katharina S Sunnerhagen Journal: Stroke Date: 2022-05-17 Impact factor: 10.170