Prospects for acute stroke— what can intensive care medicine offer?

Excerpt

Cerebro-vascular accident is the leading cause of death and long-term disability world wide, and it is therefore entirely appropriate that we should consider what critical care has to offer patients who suffer from this potentially devastating disease process [1]. The paper by Navarette-Navarro et al. [2] in this issue of Intensive Care Medicine examines the 1-year mortality and global functional outcome in "severe" stroke patients admitted to intensive care units in the south of Spain. They link this with the resource usage of such patients. In common with many of the publications of stroke management in intensive care, the principal reason for admission to the various intensive care units was initial stroke severity or clinical deterioration after the onset of symptoms. In the current paper, severity of the stroke was assessed by the APACHE III score, Glasgow Coma Score (GCS) and neurological lesion on CT scanning. Functional recovery was assessed by the Barthel index at 1 year as well as the Glasgow Outcome Scale. Patients with subarachnoid haemorrhage, intra-cerebral haemorrhage (ICH) and acute ischaemic stroke (AIS) were studied and it was found that these patients required considerable resource use, with >75% requiring mechanical ventilation and >57% vasoactive drugs. Functional recovery was predicted by admission APACHE III score and the hospital discharge Barthel index. Referral bias was noted for ICU admission, with patients of lower age being preferentially referred irrespective of viability or the potential for efficacy of critical care. …