Abstract W P234: Blood Pressure Guideline Adherence in Patients With Severe Acute Cerebrovascular Events
Background: Patients with acute cerebrovascular injuries (ischemic stroke, intracranial hemorrhages) require strict physiologic control, especially in the first hours of injury, to minimize clinical deterioration, morbidity, and death. This study aimed to assess inhospital physiologic parameter guideline compliance in these patient populations.
Methods: This IRB approved observational cohort study monitored patients with severe cerebrovascular disease admitted to the neurocritical care unit using multiple channels of physiologic data continuously recorded using the BedMasterEX (Excel Medical Electronics Inc, FL) system. This platform continuously collected hemodynamic variables (blood pressure and heart rate via arterial catheter), body temperature, and blood oxygen saturation in 5 second intervals. Raw data were initially analyzed using descriptive statistics.
Results: Fifty patients, 48% male, mean age 59.7 ±13.9 years (15 subarachnoid hemorrhages, 9 unruptured aneurysms, 6 ischemic strokes, 6 subdural hematomas, 4 intracerebral hemorrhages, 3 ischemic strokes, 1 arteriovenous malformation, 1 intraventricular hemorrhage, and 5 miscellaneous vascular injuries) were enrolled. Data acquired represented 2259 total hours of continuous blood pressure monitoring. As an example of guideline compliance, systolic blood pressure (SBP) were compared to current SBP guideline parameters and were on average outside of recommended ranges 29.4 ±30.19% of the patient’s monitoring period. We have found specifically for SBP management 6%, 28%, 18%, 12% and 36% of our patients were 99%, 90%, 80%, 70%, and <70% of the time within the specified SBP goals.
Conclusion: Hemodynamic management of patients with cerebrovascular injuries, based on current guidelines, yielded optimal control of SBP in only 34% of patients (within parameters ≥90% of time). More detailed data analyses are underway and additional physiologic variables concurrently collected with those presented here are also being studied. Future studies will further evaluate these data for potential correlation between changes in hemodynamics and clinical outcomes (worsening neurological condition, hematoma growth, re-rupture of aneurysm, hemorrhagic conversion of stroke).
Author Disclosures: G.B.F. Porto: None. A.M. Spiotta: None. E.C. Jauch: None.
- © 2014 by American Heart Association, Inc.