Long-term survival in older critically ill patients with acute ischemic stroke*

Golestanian, Ellie; Liou, Jinn-Ing; Smith, Maureen A.

doi:10.1097/ccm.0b013e3181b079b2

Cited by 41 publications

(49 citation statements)

References 39 publications

(43 reference statements)

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“…The 1-week follow-up design adopted in our study may explain this difference between our results and those of previous studies, which considered mortality rates for up to 30 days after stroke [19,23,24]. However, as very short-term mortality is more closely linked to the central effect of stroke than to its complications [39], PLEDs may be the expression of some form of dynamic brain damage in the very acute phase.…”

Section: Discussioncontrasting

confidence: 56%

EEG Patterns and Epileptic Seizures in Acute Phase Stroke

Mecarelli¹,

Pro²,

Randi³

et al. 2010

Cerebrovasc Dis

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Background: The rate of early post-stroke epileptic seizures ranges from 2 to 33%. This wide range is likely due to differences in study design, patient selection and type of neurophysiological monitoring. Electroencephalography (EEG), which is not used in the routine work-up of acute stroke, is the best neurodiagnostic technique for detecting epileptic activity, especially in patients with non-convulsive post-stroke epileptic activity. The aim of this study was to analyze patterns on EEGs performed within 24 h of stroke onset, and to investigate correlations between these patterns and the occurrence of early epileptic seizures and status epilepticus (SE), vascular risk factors, stroke subtypes and short-term outcome. Methods: We prospectively studied 232 patients (mean age 71 ± 12 years; 177 ischemic strokes and 55 hemorrhagic). EEG recording was performed within 24 h from hospitalization. The follow-up lasted 1 week. Results: Fifteen patients (6.5%) had early seizures within 24 h; 10 of these patients had focal SE with or without secondary generalization. EEG revealed sporadic epileptiform focal abnormalities in 10% and periodic lateralized epileptiform discharges (PLEDs) in 6%. SE was recorded in 71.4% of patients with PLEDs. At the multivariate analysis, only early epileptic manifestations (p < 0.001) were independently associated with PLEDs. Conclusions: Our study confirms that seizures are not frequent in the early phase of acute stroke and occur prevalently as focal SE at onset. EEG may help to detect specific patterns, such as PLEDs, that are closely related to early seizures. EEG monitoring should be performed in order to detect purely electrographic seizures.

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Section: Discussioncontrasting

confidence: 56%

EEG Patterns and Epileptic Seizures in Acute Phase Stroke

Mecarelli¹,

Pro²,

Randi³

et al. 2010

Cerebrovasc Dis

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“…In the remaining 247 patients, the median NIHSS score at admission was 12 (interquartile range [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Of the 252 patients with ischemic stroke, 97 patients (38.5%) underwent thrombolysis: intravenous thrombolysis with rtPA (85 patients), mechanical thrombectomy (5 patients) or a combination of both according to the 'bridging' concept (7 patients).…”

Section: Resultsmentioning

confidence: 99%

“…The reported mortality rates for stroke patients requiring ICU management vary widely, with a short-term mortality of more than 50% in some studies [4,5] . Newer data of a multicenter retrospective cohort study, however, report on lower mortality rates both in the short-and longterm in older ICU patients with acute ischemic stroke [6] . The wide range of mortality rates is explained by several factors, including ICU admission criteria and percentage of patients with intracerebral hemorrhage in the respective cohorts.…”

Section: Introductionmentioning

confidence: 99%

Outcome Predictors of Acute Stroke Patients in Need of Intensive Care Treatment

Alonso¹,

Ebert²,

Kern³

et al. 2015

Cerebrovasc Dis

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Background: The prognosis of stroke patients admitted to intensive care units (ICU) is commonly regarded to be poor. However, only limited data regarding outcome predictors are available. Patients and Methods: Out of 4,958 consecutive patients admitted to our stroke unit with the diagnosis of acute stroke, after analysis we identified 347 patients (164 male) in need of ICU management. In-hospital and post-rehabilitation mortality as well as functional outcome at discharge and after rehabilitation were analyzed. Results: Ischemic stroke was diagnosed in 252 patients (72.6%) and intracerebral hemorrhage occurred in 95 patients (27.4%). The mean age in our cohort was considerably high (70.8 years). One hundred patients were comatose at admission. The median NIHSS score at admission in the remaining patients was 12. Apart from stroke-related disturbances of consciousness (47.1%), the most common reasons for ICU treatment were cardiac (23.4%) and respiratory (12.1%) complications or interventional procedures requiring mechanical ventilation (11%). In all, 231/347 patients (66.6%) were mechanically ventilated (mean 84 h). In-hospital mortality (143/347; 41.2%) was associated with old age, poor NIHSS score at admission, intracerebral hemorrhage and mechanical ventilation (p < 0.001 in all). Further, admission to ICU because of stroke-related impairment of consciousness increased in-hospital mortality (p < 0.001). Similarly, poor outcome after rehabilitation was associated with old age (p = 0.029) and mechanical ventilation (p < 0.001). In patients ≥80 years with either intracerebral hemorrhage or need of mechanical ventilation, outcome was unfavorable in nearly any case. However, the overall post-rehabilitation outcome did not differ between patients with intracerebral hemorrhage and ischemic stroke (p = 0.275). Conclusion: The stroke population in our study was associated with an increased early mortality; however, given the same conditions, it was old with a high percentage of patients requiring mechanical ventilation. This did not result in increased in-hospital mortality rates compared to younger and less severely affected cohorts. Thus, ICU management is a life-saving initiative even among the elderly. However, the functional outcome was poor in older patients, thus limiting the benefits of ICU care in these patients.

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“…In ischemic stroke, as many as 40% to 70% of patients who receive prolonged MV have poor functional outcomes, 137 and this association is particularly strong in older patients (>60 years of age), those presenting in poor neurological condition (Glasgow Coma Scale score <10), and patients with preexisting brain injury. 137,138 Those with smaller posterior circulation infarcts, younger age, or higher levels of consciousness at presentation are more likely to regain independence. 139 Establishing goals of care requires prognosticating about the likelihood of surviving and the quality of life with intubation and MV compared with noninvasive treatment approaches.…”

Section: Intubation and Mechanical Ventilation Versus Do Not Intubatementioning

confidence: 99%

Palliative and End-of-Life Care in Stroke

Holloway¹,

Arnold²,

Creutzfeldt³

et al. 2014

Stroke

218

120

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Background and Purpose-The purpose of this statement is to delineate basic expectations regarding primary palliative care competencies and skills to be considered, learned, and practiced by providers and healthcare services across hospitals and community settings when caring for patients and families with stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were chosen to reflect the diversity and expertise of professional roles in delivering optimal palliative care. Writing group members were assigned topics relevant to their areas of expertise, reviewed the appropriate literature, and drafted manuscript content and recommendations in accordance with the American Heart Association's framework for defining classes and level of evidence and recommendations. Results-The palliative care needs of patients with serious or life-threatening stroke and their families are enormous: complex decision making, aligning treatment with goals, and symptom control. Primary palliative care should be available to all patients with serious or life-threatening stroke and their families throughout the entire course of illness. To optimally deliver primary palliative care, stroke systems of care and provider teams should (1) promote and practice patient-and family-centered care; (2) effectively estimate prognosis; (3) develop appropriate goals of care; (4) be familiar with the evidence for common stroke decisions with end-of-life implications; (5) assess and effectively manage emerging stroke symptoms; (6) possess experience with palliative treatments at the end of life; (7) assist with care coordination, including referral to a palliative care specialist or hospice if necessary; (8) provide the patient and family the opportunity for personal growth and make bereavement resources available if death is anticipated; and (9) actively participate in continuous quality improvement and research. Conclusions-Addressing the palliative care needs of patients and families throughout the course of illness can complement

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Long-term survival in older critically ill patients with acute ischemic stroke*

Cited by 41 publications

References 39 publications

EEG Patterns and Epileptic Seizures in Acute Phase Stroke

EEG Patterns and Epileptic Seizures in Acute Phase Stroke

Outcome Predictors of Acute Stroke Patients in Need of Intensive Care Treatment

Palliative and End-of-Life Care in Stroke

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