In Deutschland erleiden jährlich ca. 270000 Patient*innen einen Schlaganfall [1]. Die Invaliditäts- und Mortalitätsraten sind hoch (bis
zu 30%) und ein relevanter Anteil der Betroffenen muss auf der Intensivstation behandelt
werden. Der Artikel thematisiert intensivmedizinische Behandlungsaspekte des ischämischen
Schlaganfalls als häufigste Unterform (85% aller Schlaganfälle).
Abstract
In this review, we provide an update on the intensive care unit (ICU) management of
ischemic stroke. Over the last decade, new evidence has led to rapid changes in the
early management of
patients admitted with acute ischemic stroke. Nevertheless, stroke remains a leading
cause of disability. Consequently, a significant number of patients with acute ischemic
stroke require
ICU level care. The most frequent reasons for ICU admissions are large infarction
with potential swelling, reduced level of consciousness, secondary hemorrhagic transformation,
acute
symptomatic seizures or respiratory failure and stroke-related disorders of the brain–heart
interaction. Moreover, there is an increasing number of patients receiving intravenous
thrombolysis or mechanical thrombectomy with a subsequent need of ICU monitoring.
Several studies have shown that the implementation of specialized neuro-intensive
care teams help to improve
functional outcome after acute ischemic stroke. The main goal in the ICU management
of stroke patients is to prevent secondary brain injury. To this end, a comprehensive
approach to optimize
systemic physiological homeostasis, control intracranial pressure, cerebral perfusion,
hemodynamic and respiratory parameters is needed. Here, we summarize recent advances
in invasive and
non-invasive neuro-monitoring, decision making in decompressive neurosurgery for large
supratentorial or cerebellar infarction, specific cardiorespiratory management, nutrition,
temperature
management and mobilization strategies in ischemic stroke.
Schlüsselwörter
Schlaganfall - ischämischer Hirninfarkt - Intensivtherapie
Keywords
stroke - ischemic cerebral infarction - intensive care
