Outcome of intensive care unit patients with spontaneous intracerebral hemorrhage

Introduction.Length of stay (LOS) in the intensive care unit (ICU) of spontaneous intracerebral hemorrhage (sICH) patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD) to define the threshold of a prolonged ICU stay in sICH patients.Methods.This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis.Results.There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases.Conclusion.This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients’ stay in ICUs and in hospitals will be shorter if integrated care systems are established.

Download Full-text

Cost and Utility of Microbiological Cultures Early After Intensive Care Unit Admission for Intracerebral Hemorrhage

Neurocritical Care ◽

10.1007/s12028-016-0285-3 ◽

2016 ◽

Vol 26 (1) ◽

pp. 58-63 ◽

Cited By ~ 3

Author(s):

Jonathan Elmer ◽

David Yamane ◽

Peter C. Hou ◽

Susan R. Wilcox ◽

Ednan K. Bajwa ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Intracerebral Hemorrhage

Download Full-text

Abstract TP329: Early Initiation of Oral Antihypertensives Reduces Intensive Care Unit Stay and Hospital Cost in Patients With Hypertensive Intracerebral Hemorrhage

Stroke ◽

10.1161/str.51.suppl_1.tp329 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Zhu Zhu ◽

Matthew Bower ◽

Sara Stern-Nezer ◽

Steven Atallah ◽

Dana Stradling ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intracerebral Hemorrhage ◽

Resource Utilization ◽

Hospital Cost ◽

Early Initiation ◽

Control Group ◽

Study Group ◽

Significant Difference ◽

Hypertensive Intracerebral Hemorrhage

Background and Purpose: Intravenous nicardipine infusion is effective for intensive blood pressure (BP) control in patients with hypertensive intracerebral hemorrhage (ICH). However, its use requires close hemodynamic monitoring in the intensive care unit (ICU). Prompt transition from nicardipine infusion to oral antihypertensives may reduce ICU length of stay (LOS). This study aimed to examine the effect of early verse late initiation of oral antihypertensives on hospital resource utilization in patients with hypertensive ICH. Methods: This is a retrospective study of patients with hypertensive ICH and initial systolic BP ≥ 180 mmHg from January 1, 2013 to December 31, 2017. Only patients who received nicardipine infusion were included. Based on timing of receiving oral antihypertensives within or after 24 hours of emergency department arrival, patients were divided into study or control group, respectively. Baseline characteristics, duration of nicardipine infusion, ICU and hospital LOS, functional outcome at hospital discharge, and the cost were compared between the 2 groups using univariate and multivariate analysis to adjust for dependent variables. Results: A total of 166 patients (90 in study group, 76 in control group) were identified. There was no significant difference in demographic features, past medical history or initial SBP between the 2 groups. Patients in study group had lower initial NIHSS and ICH scores but higher GCS score than those in the control group. Using multivariant regression analysisto adjust for initial SBP, NIHSS, GCS and ICH scores, early initiation of oral antihypertensives was associated with significant shorter ICU LOS (median 2 vs 5, p =0.004), decreased duration of nicardipine infusion (55.5 ±60.1 vs 121.6 ±141.3, P =0.002), less pharmaceutical cost (median $14207 vs $ 29299, p =0.007) and total hospital cost (median $ 24564 vs $ 47366, p =0.007). After adjustment of confounders, there was also no significant difference in functional independence (mRS 0-2, 42.2% vs 17.1%, p =0.112) or mortality (6.7% vs 13.2%, p = 0.789) between the 2 groups. Conclusions: Early initiation of oral antihypertensive therapy is associated with reduced resource utilization and hospital cost in patients with hypertensive ICH.

Download Full-text

Age‐Specific and Sex‐Specific Trends in Life‐Sustaining Care After Acute Stroke

Journal of the American Heart Association ◽

10.1161/jaha.121.021499 ◽

2021 ◽

Author(s):

Raed A. Joundi ◽

Eric E. Smith ◽

Amy Y. X. Yu ◽

Mohammed Rashid ◽

Jiming Fang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Feeding Tube ◽

Stroke Severity ◽

Over Time ◽

Age And Sex

Background Temporal trends in life‐sustaining care after acute stroke are not well characterized. We sought to determine contemporary trends by age and sex in the use of life‐sustaining care after acute ischemic stroke and intracerebral hemorrhage in a large, population‐based cohort. Methods and Results We used linked administrative data to identify all hospitalizations for acute ischemic stroke or intracerebral hemorrhage in the province of Ontario, Canada, from 2003 to 2017. We calculated yearly proportions of intensive care unit admission, mechanical ventilation, percutaneous feeding tube placement, craniotomy/craniectomy, and tracheostomy. We used logistic regression models to evaluate the association of age and sex with life‐sustaining care and determined whether trends persisted after adjustment for baseline factors and estimated stroke severity. There were 137 358 people with acute ischemic stroke or intracerebral hemorrhage hospitalized during the study period. Between 2003 and 2017, there was an increase in the proportion receiving care in the intensive care unit (12.4% to 17.7%) and mechanical ventilation (4.4% to 6.6%). There was a small increase in craniotomy/craniectomy, a decrease in percutaneous feeding tube use, and no change in tracheostomy. Trends were generally consistent across stroke types and persisted after adjustment for comorbid conditions, stroke‐center type, and estimated stroke severity. After adjustment, women and those aged ≥80 years had lower odds of all life‐sustaining care, although the disparities in intensive care unit admission narrowed over time. Conclusions Use of life‐sustaining care after acute stroke increased between 2003 and 2017. Women and those at older ages had lower odds of intensive care, although the differences narrowed over time. Further research is needed to determine the reasons for these findings.

Download Full-text

Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage

Critical Care Medicine ◽

10.1097/00003246-200103000-00031 ◽

2001 ◽

Vol 29 (3) ◽

pp. 635-640 ◽

Cited By ~ 368

Author(s):

Michael N. Diringer ◽

Dorothy F. Edwards

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Intracerebral Hemorrhage ◽

Neurosurgical Intensive Care ◽

Neurosurgical Intensive Care Unit

Download Full-text

Hemorrhagic Moyamoya Disease during Pregnancy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100052021 ◽

2000 ◽

Vol 27 (1) ◽

pp. 73-76 ◽

Cited By ~ 10

Author(s):

John C.L. Sun ◽

Margaret Yakimov ◽

Ismail Al-Badawi ◽

Christopher R. Honey

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Cesarean Section ◽

Intracerebral Hemorrhage ◽

Moyamoya Disease ◽

Operative Management ◽

Progressive Decrease ◽

Level Of Consciousness ◽

Intraoperative Control

ABSTRACT:Background:Intracranial hemorrhage in pregnant patients with Moyamoya disease is rare. We review the case of one such patient who presented with pre-eclampsia and a catastrophic intracerebral hemorrhage in order to highlight the associated management difficulties.Methods:A case of a pregnant (31 weeks) female brought to the emergency department with hypertension and a progressive decrease in her level of consciousness is presented. She rapidly developed a dilated right pupil and left extensor posturing. A CT scan of her head showed a large putamenal intracerebral hemorrhage. She was intubated, ventilated and given intravenous mannitol and magnesium sulfate. She underwent a simultaneous craniotomy and Cesarean section. Post-operatively the patient's ICP and jugular venous saturation were monitored in the intensive care unit.Results:The patient delivered a 1185g infant who did well. The patient's ICP was well controlled until the tenth post-operative day when she developed malignant brain edema and died.Conclusion:This case highlights three important points. First, simultaneous craniotomy and Cesarean section can be performed. Second, intraoperative control of bleeding Moyamoya vessels is described. Third, the difficult post-operative management of these cases is highlighted. The literature regarding Moyamoya disease and pregnancy is reviewed and some recommendations for the management of this rare but potentially deadly condition are presented.

Download Full-text