Article

The French Society of Intensive Care (SRLF) requested medical experts to publish
recommendations on the management of stroke in the ICU for adult and pediatric
patients. The following article describes the underlying evidence used by the
experts to elaborate recommendations for general supportive treatment. Such
treatment is fundamental for victims of acute stroke to avoid neurological
worsening. Oxygen delivery in a normoxic patient is useless. However, if
saturation is below 92 %, oxygen supplementation is needed. Hyper- and
hypoglycemia worsen the neurological prognosis. As no glycemic target is known,
administration of insulin is required for glucose levels higher that 10 mmol/l.
Body temperature above 37.5 degrees is associated with poorer outcome. In the
acute phase of stroke, high blood pressure should not be lowered except in
life-threatening situations, and if so the lowering should be done cautiously.
The current consensus is to lower blood pressure if the systolic pressure is
above 220 mmHg or if the diastolic pressure is above 120 mmHg for ischemic
stroke. For hemorrhagic stroke and after thrombolysis, treatment is needed if
systolic pressure rises above 180 mmHg and if diastolic pressure is above 105
mmHg. Small doses of heparin decrease the risk of deep venous thrombosis and
pulmonary embolism without increasing cerebral bleeding. There is no consensus on
the treatment of epileptic crises after stroke and no dedicated treatment.
Further studies are needed to define adequate blood pressure and glycemic target
values in order to limit secondary worsening after an acute stroke as well as the
appropriate modalities for the treatment of epilepsy.
CI - Copyright (c) 2012 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS