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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >ICU Interventions in Ischemic Stroke Patients Treated Using Liberalized IV-tPA Criteria
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ICU Interventions in Ischemic Stroke Patients Treated Using Liberalized IV-tPA Criteria

机译：使用自由化IV-TPA标准治疗缺血性脑卒中患者的ICU干预措施

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Background and Objective: Current standard practice guidelines recommend ICU admission for ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA). More recently, the trend in stroke care is to broaden eligibility for IV thrombolysis. Two examples are a more liberal inclusion criteria known as SMART criteria (sIV-tPA), and the transfer of patients to comprehensive stroke centers (CSC). The present study characterizes ICU interventions in these patients. Understanding which stroke patients that require ICU-level care may allow for placement of patients in the appropriate level of care at hospital admission. Methods: We performed a retrospective review of consecutive transfer and nontransfer sIV-tPA-treated patients admitted to the ICU at a CSC. We evaluated the frequency, timing, and nature of ICU interventions. Results: Three hundred and thirty one patients were treated with sIV-tPA and 42% required ICU interventions during ICU admission. Of patients requiring ICU interventions, 98% had an ICU intervention performed in triage, prior to admission. National Institute of Health Stroke Scale score only had a moderate association to requirement of ICU interventions. Neither transferring patients to a CSC nor the number of standard IV-tPA contraindications increased ICU interventions. Conclusions: Liberalized IV-tPA administration did not increase ICU interventions. Nearly all patients that required ICU interventions declared this need in triage, prior to ICU admission. This timing of ICU intervention use during triage is highly sensitive for whether a patient will require ongoing ICU-level care during hospital admission. Identifying ICU intervention use in triage may allow for more effective placement of post-IV-tPA patients in the appropriate inpatient care setting, leading to better utilization of scarce ICU resources.
机译：背景技术：目前的标准实践指南推荐使用静脉内组织纤溶酶原激活剂（IV-TPA）治疗的缺血性卒中患者的ICU入院。最近，中风护理的趋势是扩大IV溶栓的资格。两个例子是称为智能标准（SIV-TPA）的更自由纳入标准，以及患者转移到综合中风中心（CSC）。本研究表征了这些患者的ICU干预措施。理解需要ICU-Lever护理的卒中患者可能允许在医院入院的适当护理水平中安置患者。方法：对CSC的连续转移和非转移SIV-TPA治疗患者进行了回顾性审查，患有CSC的ICU。我们评估了ICU干预的频率，时序和性质。结果：三百三十一名患者用SIV-TPA治疗，ICU入院期间42％的ICU干预治疗。对于需要ICU干预的患者，98％在入场前在分类中进行了ICU干预。国家卫生冲程研究所得分仅适合ICU干预的协会。既不将患者转移到CSC也不是标准IV-TPA禁忌症的数量增加了ICU干预措施。结论：自由化的IV-TPA管理没有增加ICU干预措施。几乎所有必需ICU干预的患者，在ICU入学之前都宣布了在分类中的这种需求。在分类期间的ICU干预使用的定时对患者在医院入院期间是否需要持续的ICU级别护理非常敏感。识别ICU在分类中使用的ICU干预可能允许在适当的住院护理环境中更有效地安置术后患者，从而更好地利用稀缺ICU资源。

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