Intensive Care Management

Pp. 498-510 (13)

Federico Bilotta, Martina Novelli, Filippo Pecorari and Giovanni Rosa

Abstract

Acute ischemic stroke represents a leading cause of mortality and morbidity worldwide. An increasing number of patients with massive stroke require admission to ICU for neurological monitoring and management of acute complications. Medical treatment in ICU consists of sedation, analgesia, ventilator support, hemodynamic monitoring, neuromonitoring, fluid management, thromboprophylaxis and treatment of complications. Principal complications are: cerebral edema, hemorrhage, seizures, myocardial complications, hyperglycemia and fever. Severe cerebral edema after stroke represents an important complication. In this case, decompressive craniectomy successfully decreases mortality and morbidity in patients with severe cerebral edema. Therapy with mannitol is the standard treatment for intracranial hypertension. Therapeutic hypothermia may also be considered for its neuroprotective effect but its role is not demonstrated in stroke. These aspects of critical care are considered in this chapter.

Keywords:

Acute ischemic stroke, Cerebral edema, Intensive care management, Intracranial hypertension, Neurocritical care, Neuromonitoring, Reperfusion therapy, Stroke units.

Affiliation:

Department of Anesthesiology, Critical Care and Pain Medicine, “Sapienza” University of Rome, Rome, Italy.