Acute ischaemic stroke: challenges for the intensivist

Smith, Martin; Reddy, Ugan; Robba, Chiara; Sharma, Deepak; Citerio, Giuseppe

doi:10.1007/s00134-019-05705-y

Cited by 69 publications

(73 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Criteria for ICU admission vary significantly across countries and centers. In more severe cases, ICU admission of AIS patients might be essential to ensure invasive neuro-and cardiovascular monitoring and for early detection of any multiorgan complications [71]. Continuous cardiac monitoring is essential to detect severe cardiac arrhythmias and prevent sudden cardiac death.…”

Section: Vital Signs Monitoringmentioning

confidence: 99%

Brain–heart interaction after acute ischemic stroke

et al. 2020

View full text Add to dashboard Cite

Early detection of cardiovascular dysfunctions directly caused by acute ischemic stroke (AIS) has become paramount. Researchers now generally agree on the existence of a bidirectional interaction between the brain and the heart. In support of this theory, AIS patients are extremely vulnerable to severe cardiac complications. Sympathetic hyperactivity, hypothalamic-pituitary-adrenal axis, the immune and inflammatory responses, and gut dysbiosis have been identified as the main pathological mechanisms involved in brain-heart axis dysregulation after AIS. Moreover, evidence has confirmed that the main causes of mortality after AIS include heart attack, congestive heart failure, hemodynamic instability, left ventricular systolic dysfunction, diastolic dysfunction, arrhythmias, electrocardiographic anomalies, and cardiac arrest, all of which are more or less associated with poor outcomes and death. Therefore, intensive care unit admission with continuous hemodynamic monitoring has been proposed as the standard of care for AIS patients at high risk for developing cardiovascular complications. Recent trials have also investigated possible therapies to prevent secondary cardiovascular accidents after AIS. Labetalol, nicardipine, and nitroprusside have been recommended for the control of hypertension during AIS, while beta blockers have been suggested both for preventing chronic remodeling and for treating arrhythmias. Additionally, electrolytic imbalances should be considered, and abnormal rhythms must be treated. Nevertheless, therapeutic targets remain challenging, and further investigations might be essential to complete this complex multi-disciplinary puzzle. This review aims to highlight the pathophysiological mechanisms implicated in the interaction between the brain and the heart and their clinical consequences in AIS patients, as well as to provide specific recommendations for cardiovascular management after AIS.

show abstract

Section: Vital Signs Monitoringmentioning

confidence: 99%

Brain–heart interaction after acute ischemic stroke

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In 2016, there were 9.5 million ischemic stroke patients worldwide, while in 2017, 2.7 million people died of ischemic stroke (Campbell et al, 2019). Although intravenous thrombolysis, antiplatelet aggregation, and anticoagulant therapy (Smith et al, 2019;Stoll and Nieswandt, 2019) could be used for the delivery of stroke therapies, but many apoplexy sequelae, characterized by ischemic contralateral or bilateral limb behavior disorders, memory decay, logopathy, dysphagia, and mood irritability (Zhao et al, 2016;Hou et al, 2020), have not yet cure. However, the ethnic medicine has manifested significant clinical efficacy in alleviating above unbearable symptoms or sequelae of stroke.…”

Section: Progress In Stroke Prevention and Treatment By Regulating MImentioning

confidence: 99%

Mitochondrial MPTP: A Novel Target of Ethnomedicine for Stroke Treatment by Apoptosis Inhibition

Sun

et al. 2020

Front. Pharmacol.

View full text Add to dashboard Cite

Mammalian mitochondrial permeability transition pore (MPTP), across the inner and outer membranes of mitochondria, is a nonspecific channel for signal transduction or material transfer between mitochondrial matrix and cytoplasm such as maintenance of Ca 2+ homeostasis, regulation of oxidative stress signals, and protein translocation evoked by some of stimuli. Continuous MPTP opening has been proved to stimulate neuronal apoptosis in ischemic stroke. Meanwhile, inhibition of MPTP overopening-induced apoptosis has shown excellent efficacy in the treatment of ischemic stroke. Among of which, the potential molecular mechanisms of drug therapy for stroke has also been gradually revealed by researchers. The characteristics of multi-components or multitargets for ethnic drugs also provide the possibility to treat stroke from the perspective of mitochondrial MPTP. The advantages mentioned above make it necessary for us to explore and clarify the new perspective of ethnic medicine in treating stroke and to determine the specific molecular mechanisms through advanced technologies as much as possible. In this review, we attempt to uncover the relationship between abnormal MPTP opening and neuronal apoptosis in ischemic stroke. We further summarized currently authorized drugs, ethnic medicine prescriptions, herbs, and identified monomer compounds for inhibition of MPTP overopening-induced ischemic neuron apoptosis. Finally, we strive to provide a new perspective and enlightenment for ethnic medicine in the prevention and treatment of stroke by inhibition of MPTP overopeninginduced neuronal apoptosis.

show abstract

“…In patients presenting with strokes, the complex decisionmaking around the timing of anticoagulation, and the role of mechanical thrombectomy and surgery are best addressed in high volume centres. 73 COVID-19 can present significant sedation challenges given the need for deep planes of anaesthesia in hypermetabolic patients. Despite the use of propofol 2% and a strict upper dose limit of 5 mg kg À1 h À1 , the authors have observed high rates of hypertriglyceridaemia.…”

Section: Neurological Systemmentioning

confidence: 99%

COVID-19-related organ dysfunction and management strategies on the intensive care unit: a narrative review

Sherren¹,

Ostermann²,

Agarwal

et al. 2020

British Journal of Anaesthesia

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID-19) pandemic has resulted in a significant surge of critically ill patients and an unprecedented demand on intensive care services. The rapidly evolving understanding of pathogenesis, limited disease specific evidence, and demand-resource imbalances have posed significant challenges for intensive care clinicians. COVID-19 is a complex multisystem inflammatory vasculopathy with a significant mortality implication for those admitted to intensive care. Institutional strategic preparation and meticulous intensive care support are essential to maximising outcomes during the pandemic. The significant mortality variation observed between institutions and internationally, despite a single aetiology and uniform presentation, highlights the potential influence of management strategies on outcome. Given that optimal organ support and adjunctive therapies for COVID-19 have not yet been well defined by trial-based outcomes, strategies are predicated on existing literature and experiential learning. This review outlines the relevant pathophysiology and management strategies for critically ill patients with COVID-19, and shares some of the collective learning accumulated in a high volume severe respiratory failure centre in London.

show abstract

Acute ischaemic stroke: challenges for the intensivist

Cited by 69 publications

References 84 publications

Brain–heart interaction after acute ischemic stroke

Brain–heart interaction after acute ischemic stroke

Mitochondrial MPTP: A Novel Target of Ethnomedicine for Stroke Treatment by Apoptosis Inhibition

COVID-19-related organ dysfunction and management strategies on the intensive care unit: a narrative review

Contact Info

Product

Resources

About