Blood Pressure Control in Neurological ICU Patients: What is Too High and What is Too Low?

Zaidi, Gulrukh

doi:10.2174/1874828701306010046

Cited by 5 publications

(4 citation statements)

References 50 publications

(79 reference statements)

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“…Understanding the CA status and individual LLA of a patient is highly relevant in many clinical scenarios to avoid cerebral hypoperfusion. In the neurocritical care unit, targeting MAP at the correct range in patients with neurological emergencies is critical, as both over-and undercorrection of blood pressure are associated with increased morbidity and mortality (5)(6)(7)(8)(9). During cardiopulmonary bypass (CPB) surgery, MAP targets are often lowered to reduce bleeding from collateral circulation, but a reduction in cerebral perfusion may cause unrecognized cerebral ischemia (10).…”

Section: Introductionmentioning

confidence: 99%

Determining Thresholds for Three Indices of Autoregulation to Identify the Lower Limit of Autoregulation During Cardiac Surgery*

Liu

Akiyoshi

Nakano

et al. 2020

Critical Care Medicine

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Monitoring cerebral autoregulation (CA) may help identify the lower limit of autoregulation (LLA) in individual patients. Mean arterial blood pressure (MAP) below LLA appears to be a risk factor for postoperative acute kidney injury (AKI). CA can be monitored in real-time using correlation approaches. However, the precise thresholds for different CA indexes that identify the LLA are unknown. We identified thresholds for intact autoregulation in patients during cardiopulmonary bypass surgery and examined the relevance of these thresholds to postoperative AKI. Design: A single-center retrospective analysisSetting: Tertiary academic medical center Patients. Data from 59 patients was used to determine precise CA thresholds for identification of the LLA. These thresholds were validated in a larger cohort of 226 patients. Methods and Main Results:Invasive MAP, cerebral blood flow velocities (CBFV), regional cortical oxygen saturation and total hemoglobin were recorded simultaneously. Three CA indices were calculated, including mean flow index (Mx), cerebral oximetry index (COx), and hemoglobin volume index (HVx). CA curves for the three indices were plotted, and thresholds for each index were used to generate threshold-and index-specific LLAs. A reference LLA could be identified in 59 patients by plotting CBFV against MAP to generate gold standard Lassen curves. The LLAs defined at each threshold were compared with the gold standard LLA determined from Lassen curves. The results identified the following thresholds: Mx (0.45), COx (0.35), and HVx (0.3). We then calculated the product of magnitude and duration of MAP < LLA in a larger cohort of 226 patients. When using the LLAs identified by the optimal thresholds above, MAP

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Section: Introductionmentioning

confidence: 99%

Determining Thresholds for Three Indices of Autoregulation to Identify the Lower Limit of Autoregulation During Cardiac Surgery*

Liu

Akiyoshi

Nakano

et al. 2020

Critical Care Medicine

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“…Treatment of seizure should be initiated as per current guidelines, appropriate for clinical and electrical pattern. If present, hypertensive emergency should be immediately managed as per current guidelines . One should never aim to normalize blood pressure acutely as rapid/precipitous drop can lead to cerebral ischemia.…”

Section: Discussionmentioning

confidence: 99%

A Unique Case of Rituximab-Related Posterior Reversible Encephalopathy Syndrome in a Heart Transplant Recipient With Posttransplant Lymphoproliferative Disorder

Jaiswal

Sabnani

Baran

et al. 2015

American Journal of Transplantation

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Rituximab is commonly used as a first line therapy to treat posttransplant lymphoproliferative disorders (PTLDs). It has also proved useful in the management of refractory antibody mediated graft rejection. We report an unusual case in which a heart transplant recipient being treated with rituximab for PTLD developed altered mental status, hallucinations and visual symptoms and magnetic resonance imaging (MRI) findings of symmetrical enhancement suggestive of posterior reversible leukoencephalopathy syndrome (PRES). Resolution of these clinical symptoms and radiological findings after discontinuation of therapy confirmed the diagnosis. This is the first case of PRES seen due to rituximab in a heart transplant recipient. Another unique feature of the case is the development of PRES after second cycle of rituximab as compared to prior reports in nonheart transplant patients in which the syndrome developed after first dose administration. The objective of this case report is to increase the awareness of this rare entity amongst immunocompromised transplant patients.

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“…The global incidence of ICH range is from 10 to 20 cases per 100,000 population. [1][2][3][4] Riset Kesehatan Dasar (Riskesdas) 2018 in Indonesia has shown the stroke prevalence is 10.9/mil. 5 Stroke is the leading cause of death in the neurology, and most of the strokerelated death is due to ICH.…”

Section: Introductionmentioning

confidence: 99%

“…This chronic hypertension is found in 78-88% of patients with ICH stroke. [1][2][3][4] According to the Joint National Committee (JNC) VII, the risk of a stroke starts when blood pressure is reaching 115/75 mmHg and will double for every 20mmHg systolic and 10 mmHg diastolic pressure increase. Systolic and diastolic blood pressures play a role in the occurrence of stroke.…”

Section: Introductionmentioning

confidence: 99%

Diastolic Blood Pressure as a Predictor of Mortality in Intracerebral Hemorrhage Stroke Patients with Hypertension

Juli

Gamayani

Atik³

2021

AMJ

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Background: Intracerebral hemorrhage (ICH) stroke contributes to a considerable number of deaths, ranging between 30% and 40% of the overall stroke mortality. The incidence of stroke increases with higher blood pressure. High blood pressure at the onset of ICH stroke is a strong predictor for mortality and morbidity. This study aimed to explore the role of diastolic blood pressure as a predictor of death in ICH stroke patients.Methods: Data on 113 ICH stroke patients with chronic hypertension were collected from the medical records of patients treated in the Neurology ward of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, in 2019. Data collected were patient characteristics, hypertension status, systolic and diastolic blood pressures, and patient outcome. Analysis was then performed using the Mann-Whitney test.Results: This study revealed a positive correlation (p=0.031) between diastolic blood pressure and death in ICH stroke patients with chronic hypertension.Conclusion: High diastolic blood pressure is associated with mortality in ICH stroke patients with chronic hypertension.

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Blood Pressure Control in Neurological ICU Patients: What is Too High and What is Too Low?

Cited by 5 publications

References 50 publications

Determining Thresholds for Three Indices of Autoregulation to Identify the Lower Limit of Autoregulation During Cardiac Surgery*

Determining Thresholds for Three Indices of Autoregulation to Identify the Lower Limit of Autoregulation During Cardiac Surgery*

A Unique Case of Rituximab-Related Posterior Reversible Encephalopathy Syndrome in a Heart Transplant Recipient With Posttransplant Lymphoproliferative Disorder

Diastolic Blood Pressure as a Predictor of Mortality in Intracerebral Hemorrhage Stroke Patients with Hypertension

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