İnme
Özet
Akut iskemik inmenin (AIS) tedavisi, kritik bakım uzmanının katılımını her zamankinden daha fazla gerektiren multidisipliner bir yaklaşımdan oluşur. Yoğun bakım ünitesi düzeyinde bakım gerektiren akut iskemik inme hastalarının özellikleri arasında hava yolu veya solunum sıkıntısı; beyin ödemi ile birlikte büyük serebral veya serebellar hemisferik enfarktüsü ; semptomatik hemorajik dönüşüm ile enfarktüs; nöbetlerle komplike olan enfarktüs;ve trombolitiklerden sonra kan basıncının yakından yönetilmesini içerir. Bu bölümde, trombolitik tedavi, endovasküler tedavi, nörodiagnostik ve görüntüleme, kan basıncı yönetimi, glisemik kontrol, sıcaklık yönetimi kapsayan, bir nörointensivist için özellikle önemli olan akut iskemik inme bakımının aşamalarını tartışıyoruz . Ayrıca intravenöz tromboliz veya mekanik trombektomi uygulanan hastaların bakımına da odaklanıyoruz.
Referanslar
Aho, K., et al., Cerebrovascular disease in the community: results of a WHO collaborative study. Bulletin of the World Health Organization, 1980. 58(1): p. 113.
Krishnamurthi, R.V., T. Ikeda, and V.L. Feigin, Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: a systematic analysis of the global burden of disease study 2017. Neuroepidemiology, 2020. 54(2): p. 171-179.
Feigin, V.L., et al., World Stroke Organization (WSO): global stroke fact sheet 2022. International Journal of Stroke, 2022. 17(1): p. 18-29.
Caplan, L.R., Stroke: A clinical approach. 1993: Butterworth-Heinemann Medical.
Arı Sevingil, S., İnme Sendromları ve Tanımları, in Acil İnme Yönetimi. 2020, ESOGU Basımevi: Eskişehir. p. 1-12.
Arı Sevingil, S., Özdemir,AÖ, Sereberovasküler Hastalıklar ve Uyku, in Uyku Nörofizyolojisi ve Hastalıkları, G. Benbir Şenel, Editor. 2022, Bayçınar Tıbbi Yayıncıılık: Ankara. p. 345-360.
Faigle, R., et al., ICAT: a simple score predicting critical care needs after thrombolysis in stroke patients. Critical Care, 2015. 20: p. 1-8.
Herpich, F. and F. Rincon, Management of acute ischemic stroke. Critical care medicine, 2020. 48(11): p. 1654.
Yan, L.L., et al., Midlife body mass index and hospitalization and mortality in older age. Jama, 2006. 295(2): p. 190-198.
Rao, C.P.V. and J.I. Suarez, Management of stroke in the neurocritical care unit. CONTINUUM: Lifelong Learning in Neurology, 2018. 24(6): p. 1658-1682.
Arı Sevingil, S.G.L., Nöroloji Yoğun Bakımda Blinmesi Gereken İlaçlar, in Nörolojik Yoğun Bakım Temel Kitabı, T.M. Şirin H, Editor. 2022, Türk Nöroloji Derneği. p. 296-306.
Powers, W.J., et al., 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2018. 49(3): p. e46-e110.
Bakanlığı, T.S., Akut iskemik inmede tanı ve tedavi rehberi, Ankara, 2020.
Rangaraju, S., et al., Pittsburgh outcomes after stroke thrombectomy score predicts outcomes after endovascular therapy for anterior circulation large vessel occlusions. Stroke, 2014. 45(8): p. 2298-2304.
Yarbrough, C.K., et al., Endovascular thrombectomy for anterior circulation stroke: systematic review and meta-analysis. Stroke, 2015. 46(11): p. 3177-3183.
Fuhrer, H., et al., Endovascular stroke treatment’s impact on malignant type of edema (ESTIMATE). Journal of Neurology, 2019. 266(1): p. 223-231.
Diedler, J., et al., Intensive care management of acute stroke: general management. International Journal of Stroke, 2009. 4(5): p. 365-378.
Horner, J., et al., Dysphagia following brain-stem stroke: clinical correlates and outcome. Archives of Neurology, 1991. 48(11): p. 1170-1173.
Becker, K., Intensive care unit management of the stroke patient. Neurologic clinics, 2000. 18(2): p. 439-454.
Jauch, E.C., et al., Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2013. 44(3): p. 870-947.
Yaghi, S., et al., Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2017. 48(12): p. e343-e361.
Gore, J.M., et al., Intracerebral hemorrhage, cerebral infarction, and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the Thrombolysis in Myocardial Infarction Study. Thrombolysis in Myocardial Infarction, Phase II, pilot and clinical trial. Circulation, 1991. 83(2): p. 448-459.
Mayer, S.A., et al., Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension registry. Critical care medicine, 2011. 39(10): p. 2330-2336.
Shulkin, D.J., et al., Impact of systems of care and blood pressure management on stroke outcomes. Population health management, 2011. 14(6): p. 267-275.
Anadani, M., et al., Blood pressure and outcome after mechanical thrombectomy with successful revascularization: a multicenter study. Stroke, 2019. 50(9): p. 2448-2454.
Godoy, D.A., M. Di Napoli, and A.A. Rabinstein, Treating hyperglycemia in neurocritical patients: benefits and perils. Neurocritical care, 2010. 13: p. 425-438.
Cook, A.M., et al., Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocritical care, 2020. 32: p. 647-666.
Rubiano, A.M., A. Figaji, and G.W. Hawryluk, Intracranial pressure management: moving beyond guidelines. Current Opinion in Critical Care, 2022. 28(2): p. 101-110.
Fink, M.E., Osmotherapy for intracranial hypertension: mannitol versus hypertonic saline. CONTINUUM: Lifelong Learning in Neurology, 2012. 18(3): p. 640-654.
Hacke, W., et al., 'Malignant'middle cerebral artery territory infarction: clinical course and prognostic signs. Archives of neurology, 1996. 53(4): p. 309-315.
Heiferman, D.M., et al., Predictors of Decompressive Hemicraniectomy in Successfully Recanalized Patients With Anterior Circulation Emergency Large‐Vessel Occlusion. Stroke: Vascular and Interventional Neurology, 2022. 2(5): p. e000252.
Vahedi, K., et al., Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. The Lancet Neurology, 2007. 6(3): p. 215-222.
Schneider, G.-H., et al. Influence of hyperventilation on brain tissue-PO 2, PCO 2, and pH in patients with intracranial hypertension. in Intracranial Pressure and Neuromonitoring in Brain Injury: Proceedings of the Tenth International ICP Symposium, Williamsburg, Virginia, May 25–29, 1997. 1998. Springer.
Indredavik, B., et al., Medical complications in a comprehensive stroke unit and an early supported discharge service. Stroke, 2008. 39(2): p. 414-420.
Lindsberg, P.J. and A.J. Grau, Inflammation and infections as risk factors for ischemic stroke. Stroke, 2003. 34(10): p. 2518-2532.
Saini, M., et al., Effect of hyperthermia on prognosis after acute ischemic stroke. Stroke, 2009. 40(9): p. 3051-3059.
Neugebauer, H., et al., Outcomes of hypothermia in addition to decompressive hemicraniectomy in treatment of malignant middle cerebral artery stroke: a randomized clinical trial. JAMA neurology, 2019. 76(5): p. 571-579.
Madden, L.K., et al., The implementation of targeted temperature management: an evidence-based guideline from the Neurocritical Care Society. Neurocritical care, 2017. 27: p. 468-487.
Bravata, D.M., et al., Processes of care associated with acute stroke outcomes. Archives of internal medicine, 2010. 170(9): p. 804-810.
Kellert, L., et al., The impact of low hemoglobin levels and transfusion on critical care patients with severe ischemic stroke: STroke: RelevAnt Impact of HemoGlobin, Hematocrit and Transfusion (STRAIGHT)—an observational study. Journal of critical care, 2014. 29(2): p. 236-240.
Burn, J., et al., Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. Bmj, 1997. 315(7122): p. 1582-1587.
Claassen, J. and J.N. Goldstein, Emergency neurological life support: status epilepticus. Neurocritical care, 2017. 27: p. 152-158.
Referanslar
Aho, K., et al., Cerebrovascular disease in the community: results of a WHO collaborative study. Bulletin of the World Health Organization, 1980. 58(1): p. 113.
Krishnamurthi, R.V., T. Ikeda, and V.L. Feigin, Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: a systematic analysis of the global burden of disease study 2017. Neuroepidemiology, 2020. 54(2): p. 171-179.
Feigin, V.L., et al., World Stroke Organization (WSO): global stroke fact sheet 2022. International Journal of Stroke, 2022. 17(1): p. 18-29.
Caplan, L.R., Stroke: A clinical approach. 1993: Butterworth-Heinemann Medical.
Arı Sevingil, S., İnme Sendromları ve Tanımları, in Acil İnme Yönetimi. 2020, ESOGU Basımevi: Eskişehir. p. 1-12.
Arı Sevingil, S., Özdemir,AÖ, Sereberovasküler Hastalıklar ve Uyku, in Uyku Nörofizyolojisi ve Hastalıkları, G. Benbir Şenel, Editor. 2022, Bayçınar Tıbbi Yayıncıılık: Ankara. p. 345-360.
Faigle, R., et al., ICAT: a simple score predicting critical care needs after thrombolysis in stroke patients. Critical Care, 2015. 20: p. 1-8.
Herpich, F. and F. Rincon, Management of acute ischemic stroke. Critical care medicine, 2020. 48(11): p. 1654.
Yan, L.L., et al., Midlife body mass index and hospitalization and mortality in older age. Jama, 2006. 295(2): p. 190-198.
Rao, C.P.V. and J.I. Suarez, Management of stroke in the neurocritical care unit. CONTINUUM: Lifelong Learning in Neurology, 2018. 24(6): p. 1658-1682.
Arı Sevingil, S.G.L., Nöroloji Yoğun Bakımda Blinmesi Gereken İlaçlar, in Nörolojik Yoğun Bakım Temel Kitabı, T.M. Şirin H, Editor. 2022, Türk Nöroloji Derneği. p. 296-306.
Powers, W.J., et al., 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2018. 49(3): p. e46-e110.
Bakanlığı, T.S., Akut iskemik inmede tanı ve tedavi rehberi, Ankara, 2020.
Rangaraju, S., et al., Pittsburgh outcomes after stroke thrombectomy score predicts outcomes after endovascular therapy for anterior circulation large vessel occlusions. Stroke, 2014. 45(8): p. 2298-2304.
Yarbrough, C.K., et al., Endovascular thrombectomy for anterior circulation stroke: systematic review and meta-analysis. Stroke, 2015. 46(11): p. 3177-3183.
Fuhrer, H., et al., Endovascular stroke treatment’s impact on malignant type of edema (ESTIMATE). Journal of Neurology, 2019. 266(1): p. 223-231.
Diedler, J., et al., Intensive care management of acute stroke: general management. International Journal of Stroke, 2009. 4(5): p. 365-378.
Horner, J., et al., Dysphagia following brain-stem stroke: clinical correlates and outcome. Archives of Neurology, 1991. 48(11): p. 1170-1173.
Becker, K., Intensive care unit management of the stroke patient. Neurologic clinics, 2000. 18(2): p. 439-454.
Jauch, E.C., et al., Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2013. 44(3): p. 870-947.
Yaghi, S., et al., Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2017. 48(12): p. e343-e361.
Gore, J.M., et al., Intracerebral hemorrhage, cerebral infarction, and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the Thrombolysis in Myocardial Infarction Study. Thrombolysis in Myocardial Infarction, Phase II, pilot and clinical trial. Circulation, 1991. 83(2): p. 448-459.
Mayer, S.A., et al., Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension registry. Critical care medicine, 2011. 39(10): p. 2330-2336.
Shulkin, D.J., et al., Impact of systems of care and blood pressure management on stroke outcomes. Population health management, 2011. 14(6): p. 267-275.
Anadani, M., et al., Blood pressure and outcome after mechanical thrombectomy with successful revascularization: a multicenter study. Stroke, 2019. 50(9): p. 2448-2454.
Godoy, D.A., M. Di Napoli, and A.A. Rabinstein, Treating hyperglycemia in neurocritical patients: benefits and perils. Neurocritical care, 2010. 13: p. 425-438.
Cook, A.M., et al., Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocritical care, 2020. 32: p. 647-666.
Rubiano, A.M., A. Figaji, and G.W. Hawryluk, Intracranial pressure management: moving beyond guidelines. Current Opinion in Critical Care, 2022. 28(2): p. 101-110.
Fink, M.E., Osmotherapy for intracranial hypertension: mannitol versus hypertonic saline. CONTINUUM: Lifelong Learning in Neurology, 2012. 18(3): p. 640-654.
Hacke, W., et al., 'Malignant'middle cerebral artery territory infarction: clinical course and prognostic signs. Archives of neurology, 1996. 53(4): p. 309-315.
Heiferman, D.M., et al., Predictors of Decompressive Hemicraniectomy in Successfully Recanalized Patients With Anterior Circulation Emergency Large‐Vessel Occlusion. Stroke: Vascular and Interventional Neurology, 2022. 2(5): p. e000252.
Vahedi, K., et al., Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. The Lancet Neurology, 2007. 6(3): p. 215-222.
Schneider, G.-H., et al. Influence of hyperventilation on brain tissue-PO 2, PCO 2, and pH in patients with intracranial hypertension. in Intracranial Pressure and Neuromonitoring in Brain Injury: Proceedings of the Tenth International ICP Symposium, Williamsburg, Virginia, May 25–29, 1997. 1998. Springer.
Indredavik, B., et al., Medical complications in a comprehensive stroke unit and an early supported discharge service. Stroke, 2008. 39(2): p. 414-420.
Lindsberg, P.J. and A.J. Grau, Inflammation and infections as risk factors for ischemic stroke. Stroke, 2003. 34(10): p. 2518-2532.
Saini, M., et al., Effect of hyperthermia on prognosis after acute ischemic stroke. Stroke, 2009. 40(9): p. 3051-3059.
Neugebauer, H., et al., Outcomes of hypothermia in addition to decompressive hemicraniectomy in treatment of malignant middle cerebral artery stroke: a randomized clinical trial. JAMA neurology, 2019. 76(5): p. 571-579.
Madden, L.K., et al., The implementation of targeted temperature management: an evidence-based guideline from the Neurocritical Care Society. Neurocritical care, 2017. 27: p. 468-487.
Bravata, D.M., et al., Processes of care associated with acute stroke outcomes. Archives of internal medicine, 2010. 170(9): p. 804-810.
Kellert, L., et al., The impact of low hemoglobin levels and transfusion on critical care patients with severe ischemic stroke: STroke: RelevAnt Impact of HemoGlobin, Hematocrit and Transfusion (STRAIGHT)—an observational study. Journal of critical care, 2014. 29(2): p. 236-240.
Burn, J., et al., Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. Bmj, 1997. 315(7122): p. 1582-1587.
Claassen, J. and J.N. Goldstein, Emergency neurological life support: status epilepticus. Neurocritical care, 2017. 27: p. 152-158.
