Abstract WP448: Shorter Intensive Care Unit Stay (12 Hours) Post Thrombolysis is Safe and Reduces Length of Stay for Minor Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tricia Tubergen ◽  
Laurel Packard ◽  
Danielle Gritters ◽  
Hattie LaCroix ◽  
Andrea Goosen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Bed Rest ◽  
Tissue Type ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Patients ◽  
Icu Stay

Background and Purpose: Acute Stroke Patients treated with intravenous tissue-type plasminogen activator (tPA) require intensive care unit (ICU) monitoring for 24 hours post-treatment due to risk of symptomatic intracranial hemorrhage (sICH). This is a costly and resource intensive practice. In this study, we evaluated the safety and efficacy of shorter ICU monitoring for minor stroke patients treated with tPA. Methods: Consecutive patients age >18 years with a diagnosis of ischemic stroke that received tPA only and who had an initial National Institute of Health Stroke Scale (NIHSS) 0-5 between 1/1/2017 and 3/30/2019 were included. Stroke mimics and those who underwent thrombectomy were excluded. Standard practice 24 hour ICU stay prior to 05/15/2018 was compared with 12 hour ICU stay after that date. The primary outcome was length of stay. Secondary outcome measures included sICH, deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, favorable discharge to home or acute rehabilitation, readmission within 30 days, and modified rankin scale (mRS) at 90 days. Results: Of the 122 patients identified, 77 patients were in the 24-hour protocol and 45 were in 12-hour ICU stay protocol groups. There was significant difference in length of stay for the 24-hour ICU stay protocol (2.8 days) compared with the 12-hour ICU stay protocol (1.8 days) ( P <.001). Compared with the 24-hour ICU stay, the rates of sICH ( p = .65), DVT ( p = NS), PE ( p = NS), pneumonia ( p = 1.00), favorable discharge disposition ( p = .26), 30 day readmission ( p =0.06) and 90 day mRS 0-2 ( p = .37) were not different between the groups. Conclusion: Compared with 24-hour bed rest, 12-hour bed rest after thrombolysis for minor acute ischemic stroke was associated with without any adverse outcomes. A randomized trial is needed to verify these findings.

Abstract WP447: Early Mobilization After 12 Hours Post-Thrombolysis is Safe and Reduces Length of Stay in Minor Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Laurel Packard ◽  
Tricia Tubergen ◽  
Hattie LaCroix ◽  
Danielle Gritters ◽  
Nicholas Ames ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Bed Rest ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Patients ◽  
Discharge Disposition ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Background: Bed rest of 24 hours post-thrombolysis is recommended for acute ischemic stroke patients. We sought to compare outcomes and in-hospital complications of 12- and 24-hour bed rest protocols following thrombolysis in minor stroke patients. Methods: Consecutive patients age >18 years with a diagnosis of ischemic stroke that received tPA only and who had an initial National Institute of Health Stroke Scale (NIHSS) 0-5 between 1/1/2017 and 3/30/2019 were included. Stroke mimics and patients who underwent mechanical thrombectomy were excluded. The standard practice bed rest order for the 24 hour protocol prior to 07/15/2017 was compared with the 12 hour bed rest order protocol after that date. The primary outcome was length of stay. Secondary outcome measures included symptomatic intracerebral hemorrhage (sICH), deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, favorable discharge to home or acute rehabilitation, readmission within 30 days and modified rankin scale (mRS) at 90 days. Results: Of the 106 patients identified, 36 patients were in the 24-hour protocol and 70 were in the 12-hour bed rest protocol group. There was significant difference for length of stay in the 24-hour bed rest protocol (2.9 days) compared with the 12-hour bed rest protocol (2.0 days) (p=0.032). Compared with the 24-hour bed rest group, the rates of sICH (p=NS), DVT (p=NS), PE (p=NS), pneumonia (p=NS), favorable discharge disposition (p=NS), 30 day readmission (p=0.NS) and 90 day mRS 0-2 (p=NS) were not different between the groups. Time to mobilization was significantly different between the two groups (24 hour group:2043.2 ± 680.1 minutes; 12 hour group:1221.0 ± 527.8) (p<0.0001). Conclusion: Compared with 24-hour bed rest, 12-hour bed rest after thrombolysis for minor acute ischemic stroke was associated with significantly earlier patient mobilization and reduced length of stay without any adverse outcomes. A randomized trial is needed to verify these findings.

Abstract TP405: IV TPA Utilization and Outcomes in Young Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pamela Cheng ◽  
Ling Zheng ◽  
Steven Cen ◽  
Peggy Nguyen ◽  
Sebina Bulic ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Average Length ◽  
Pediatric Population ◽  
Cerebrovascular Disorders ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Total Charge ◽  
Inpatient Mortality ◽  
Stroke Patients

Objective: Cerebrovascular disorders are among the top ten causes of death in the pediatric population. The incidence is felt to be 1-2 per 100,000, although this number could be higher due to poor recognition. Our objective is to describe the incidence, tPA utilization, inpatient mortality, length of stay, and cost associated with stroke in pediatric population. Methods: Ischemic stroke cases between the ages of 1 and 17 years were obtained from the Nationwide Inpatient Sample (NIS) for the period from January 1, 2000 through December 31, 2014. The primary outcome was inpatient mortality. The secondary outcome was LOS and total cost per day. National trend estimate followed HCUP methodical standard which adopted the design change at 2012 with appropriate trend weight. Weighted estimates were made via SURVEYMEAN procedure and presented as national estimate ± standard error from sampling. SAS9.4 was used for the analysis. Results: From January 2000 through December 2014, there were an estimated 12908±1087 pediatric cases with ischemic stroke, 157±28 (1.2%±0.2%) had TPA. Pediatric ischemic stroke patients were predominantly discharged from urban, large-bed-size, teaching hospitals (40.7%±3.9%), more likely to be white (39.3%±1.8%) and male (52.5%±1.2%), most prevalent among those aged 16 years old (10.3%±0.8%). Overall inpatient mortality was 3.0±0.3 per 100 discharges. Median LOS was 4.0±0.1 days. Median total charge per day was $ 8162±348. Majority of pediatric ischemic stroke patients discharged routinely to home or self-care (75.8%±1.2%). Conclusion: This study highlights that during the prespecified time frame of four years there was an estimated 12908±1087 ischemic strokes in the pediatric population and less than 2% of children received alteplase. Hospital mortality was 3.0% ± 0.3%. The average length of stay was 4 days with an estimated cost of $8162+/- 348 per day. The majority of pediatric patients were discharged home.

scholarly journals Among Trauma Patients, Younger Men with Ventilator-Associated Pneumonia Have Worse Outcomes Compared to Older Men—An Exploratory Study

Healthcare ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 67
Author(s):  
Duraid Younan ◽  
Sarah Delozier ◽  
Nathaniel McQuay ◽  
John Adamski ◽  
Aisha Violette ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Older Men ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Icu Stay ◽  
Younger Men

Background: Ventilator-associated pneumonia is associated with significant morbidity. Although the association of gender with outcomes in trauma patients has been debated for years, recently, certain authors have demonstrated a difference. We sought to compare the outcomes of younger men and women to older men and women, among critically ill trauma patients with ventilator-associated pneumonia (VAP). Methods: We reviewed our trauma data base for trauma patients with ventilator-associated pneumonia admitted to our trauma intensive care unit between January 2016 and June 2018. Data collected included demographics, injury mechanism and severity (ISS), admission vital signs and laboratory data and outcome measures including hospital length of stay, ICU stay and survival. Patients were also divided into younger (<50) and older (≥50) to account for hormonal status. Linear regression and binary logistic regression models were performed to compare younger men to older men and younger women to older women, and to examine the association between gender and hospital length of stay (LOS), ICU stay (ICUS), and survival. Results: Forty-five trauma patients admitted to our trauma intensive care unit during the study period (January 2016 to August 2018) had ventilator-associated pneumonia. The average age was 58.9 ± 19.6 years with mean ISS of 18.2 ± 9.8. There were 32 (71.1%) men, 27 (60.0%) White, and 41 (91.1%) had blunt trauma. Mean ICU stay was 14.9 ± 11.4 days and mean total hospital length of stay (LOS) was 21.5 ± 14.6 days. Younger men with VAP had longer hospital LOS 28.6 ± 17.1 days compared to older men 16.7 ± 6.6 days, (p < 0.001) and longer intensive care unit stay 21.6 ± 15.6 days compared to older men 11.9 ± 7.3 days (p = 0.02), there was no significant difference in injury severity (ISS was 22.2 ± 8.4 vs. 17 ± 8, p = 0.09). Conclusions: Among trauma patients with VAP, younger men had longer hospital length of stay and a trend towards longer ICU stay. Further research should focus on the mechanisms behind this difference in outcome using a larger database.

scholarly journals Role of the Neurosurgeon in Acute Ischemic Stroke Treatment From Triage to Intensive Care Unit

Neurosurgery ◽  
2019 ◽  
Vol 85 (suppl_1) ◽  
pp. S47-S51
Author(s):  
Kimberly P Kicielinski ◽  
Christopher S Ogilvy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Setting ◽  
Stroke Treatment

Abstract As ischemic stroke care advances with more patients eligible for mechanical thrombectomy, so too does the role of the neurosurgeon in these patients. Neurosurgeons are an important member of the team from triage through the intensive care unit. This paper explores current research and insights on the contributions of neurosurgeons in care of acute ischemic stroke patients in the acute setting.

The Impact of Hyperthermia and Infection on Acute Ischemic Stroke Patients in the Intensive Care Unit

2008 ◽  
Vol 9 (2) ◽  
pp. 183-188 ◽  
Author(s):  
Woo-Keun Seo ◽  
Sung-Wook Yu ◽  
Ji Hyun Kim ◽  
Kun-Woo Park ◽  
Seong-Beom Koh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
The Impact

Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

2018 ◽  
Vol 42 (5) ◽  
pp. 274-282
Author(s):  
L. Viña Soria ◽  
L. Martín Iglesias ◽  
L. López Amor ◽  
I. Astola Hidalgo ◽  
R. Rodríguez García ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Stroke Patients

scholarly journals Potential drug-drug interactions in acute ischemic stroke patients at the Neurological Intensive Care Unit

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 813-826
Author(s):  
Dejan Z. Aleksic ◽  
Slobodan M. Jankovic ◽  
Milos N. Mlosavljevic ◽  
Gordana L. Toncev ◽  
Svetlana D. Miletic Drakulic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Drug Interactions ◽  
Acute Ischemic Stroke ◽  
Potential Drug ◽  
Drug Reactions ◽  
Stroke Patients ◽  
Neurological Intensive Care Unit ◽  
Neurological Intensive Care

AbstractBackgroundClinically relevant potential drug-drug interactions are considered preventable adverse drug reactions.ObjectiveThe aim of this study was to ascertain the frequency of potential drug-drug interactions in acute ischemic stroke patients and to explore factors associated with occurrence of potentially contraindicated drug-drug interactions.MethodsThis observational retrospective cohort and nested case-control study was carried out among patients treated for acute ischemic stroke at the Neurological Intensive Care Unit in the Clinical Centre Kragujevac, Serbia. The potentially drug-drug interactions for each day of hospitalization were identifi ed using Micromedex® soft ware. Based on the existence or absence of potentially contraindicated drug-drug interactions, the participants were divided into a group of cases (n=111) and the control group (n=444).ResultsA total of 696 patients were analysed. All patients had a minimum of one potential drug-drug interaction during hospitalization. The most common drugs involved in potential drug-drug interactions were aspirin (8.02%), diclofenac (7.49%) and warfarin (7.14%). The number of medications prescribed for simultaneous use during hospitalisation and the use of antipsychotics in therapy signifi cantly increased the likelihood of potentially contraindicated drug-drug interactions aft er adjustment by means of logistic regression for 1.2 and 3 times, respectively.ConclusionsThis study suggests that patients with acute ischemic stroke are frequently exposed to potential drug-drug interactions. It is essential to identify potentially drug-drug interactions in these patients as early as possible in order to prevent adverse drug reactions and ensure safe recovery. Besides, full attention should be paid when adding each new medication in therapy, particularly when a neurologist decides to prescribe antipsychotics, such as risperidone.

scholarly journals Stroke Mortality in Intensive Care Unit from Tertiary Care Neurological Center

2013 ◽  
Vol 52 (190) ◽  
Author(s):  
Lekhjung Thapa ◽  
Asis Shrestha ◽  
Baburam Pokhrel ◽  
Raju Paudel ◽  
Parmendra Vir Singh Rana
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Intensive Care Unit Mortality ◽  
Tertiary Care ◽  
Stroke Care ◽  
Uncontrolled Hypertension ◽  
Stroke Mortality ◽  
Stroke Patients

Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by 6 months, and a half by 1 year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, intensive care unit has remained the choice for stroke patients’ care in developing countries. This study explores the mortality of stroke patients in intensive care unit setting in tertiary care neurological centre in a developing country.Methods: We collected data of stroke patients admitted in our ICU from August 2009 to Aug 2010 and analyzed.Results: Total 44 (10.25%) patients were admitted for acute stroke. Age ranged from 17-93 years. Low GCS (Glasgow Coma Scale), uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3%) patients had hemorrhagic stroke and 21(47.7%) patients had ischemic stroke. 13 (29.54%) patients of stroke died within 7 days, 9 (69.23%) patients of hemorrhagic stroke died within 6 days, and 4 patients (30.76%) of ischemic stroke died within 7 days. 6 (13.63%) patients left hospital against medical advice. All of these patients had ischemic stroke.Conclusions: Stroke mortality in intensive care unit remains high despite of care in tertiary neurological center in resource poor settings. Stroke care unit, which would also help dissemination of knowledge of stroke management, is an option for improved outcome in developing countriesKeywords: intensive care unit; mortality; stroke; stroke care unit.

Laboratory Abnormalities in Patients in the Medical Intensive Care Unit

1996 ◽  
Vol 12 (1) ◽  
pp. 12-15
Author(s):  
Margie B Zak ◽  
Carl F Dmuchowski ◽  
Maureen A Smythe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Medical Intensive Care Unit ◽  
Retrospective Chart Review ◽  
Serum Electrolyte ◽  
Laboratory Parameters ◽  
Icu Stay ◽  
Medical Intensive Care ◽  
Length Of Icu Stay

Objective: The goals of this article are to (1) identify the incidence of reported laboratory abnormalities in patients in the medical intensive care unit (ICU); (2) characterize the relationship between reported laboratory abnormalities and Acute Physiology and Chronic Health Evaluation III (APACHE III) score, length of stay, and mortality; and (3) evaluate therapeutic replacement in patients with electrolyte abnormalities. Design: Retrospective chart review of all patients admitted to the medical ICU between April 1, 1993 and June 30, 1993. Setting: Large teaching institution. Participants: Patients admitted to the medical ICU (n = 116). Interventions: The following data were collected: age, sex, admitting diagnosis, serum electrolyte and laboratory parameters, APACHE HI score, length of ICU stay, and mortality. Results: Ten individual laboratory abnormalities were found in more than 30% of all patients in the medical ICU (range 32.8–59.5%). Abnormalities in four laboratory parameters were associated with undesirable patient outcomes. Patients with hypoalbuminemia had a significantly higher APACHE HI score (p < 0.05). Hypocalcemia, hypomagnesemia, and hypoalbuminemia all were associated with an increased length of stay in the ICU (p < 0.05). Overall mortality was significantly higher in patients with alkalosis (p = 0.002). Therapeutic replacement in those with low electrolyte concentrations often was delayed or missed. Fifteen to 75% of patients who had abnormally low serum electrolyte concentrations were not treated. Conclusions: A high incidence of laboratory abnormalities is reported in patients admitted to the medical ICU. Several of these abnormalities are associated with undesirable outcomes such as an increased length of ICU stay in patients with hypoalbuminemia, hypocalcemia, and hypomagnesemia and increased mortality in patients with alkalosis. Therapeutic replacement of electrolytes in patients with abnormalities often was delayed or missed.

scholarly journals Mortality of ischemic stroke patients admitted to the intensive care unit in Sultan Qaboos University Hospital

2020 ◽  
Vol 2019 (2) ◽  
Author(s):  
Fatema Hamood Saif Al-Busaidi ◽  
Faris Abdullah Hamed Al-Farsi ◽  
Mujahed Al-Busaidi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
University Hospital ◽  
Stroke Patients ◽  
Sultan Qaboos University
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