Outcomes of Patients Admitted to the ICU for Acute Stroke

A Retrospective Cohort

Thibaut Carval; Charlotte Garret; Benoôt Guillon; Jean-Baptiste Lascarrou; Maëlle Martin; Jérémie Lemarié; Julien Dupeyrat; Amélie Seguin; Olivier Zambon; Jean Reignier; Emmanuel Canet

Disclosures

BMC Anesthesiol. 2022;22(235) 

In This Article

Background

Stroke is a common event and a major cause of hospitalization, disability, and mortality worldwide.[1] Major therapeutic advances have occurred in the past decade, including the development of dedicated stroke units, the introduction of reperfusion therapy and interventional neuroradiology, and the performance of acute neurosurgical interventions in selected patients.[2–4] In clinical trials, these treatments decreased mortality and improved disability-free survival.[5–7]

However, a growing number of stroke patients require ICU admission for either neurological monitoring or the management of stroke complications, with 10–30% becoming critically ill.[8–10] In addition, stroke patients without treatment options are increasingly being admitted to the ICU to facilitate organ donation. Among patients with stroke, significant differences exist between those admitted to ICUs and those admitted to neurological wards or stroke units. The ICU group is characterized by greater neurological severity, as measured using validated tools (e.g., the National Institutes of Health Stroke Scale, NIHSS);[11] moderate-to-severe consciousness impairment; a need for mechanical ventilation in many cases;[9,12] and high hospital mortality. Data are limited on the potential benefits of acute-phase stroke therapy in ICU patients.[8,13–15] Moreover, experts recently emphasized the importance of focusing research not only on short-term survival but also on long-term functional outcomes of critically ill stroke patients, in order to improve communication with patients and relatives and to determine the appropriate level of care.[8,16]

The objectives of this study were to describe the clinical features, management, and outcomes of patients admitted to the ICU for acute stroke and to identify predictors of neurological outcome 6 months after ICU admission.

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