Intensive Care Management
Pp. 498-510 (13)
Federico Bilotta, Martina Novelli, Filippo Pecorari and Giovanni Rosa
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
Acute ischemic stroke, Cerebral edema, Intensive care management,
Intracranial hypertension, Neurocritical care, Neuromonitoring, Reperfusion
therapy, Stroke units.
Department of Anesthesiology, Critical Care and Pain Medicine, “Sapienza” University of Rome, Rome, Italy.