In addition to reperfusion therapy, the critical care management of patients with an acute ischemic stroke also includes airway and ventilation management, hemodynamic management, glucose control, anticoagulation management, and surgery in select cases.
Consider the following management pearls:
Mechanical ventilation
Target SpO2 > 94% (avoid supplemental oxygen for non-hypoxemic patients)
Target normocarbia (PaCO2 35-45 mmHg)
Hemodynamics
Target euvolemia with isotonic saline
Target BP < 185/110 mmHg for 24 hrs after tPA
Target BP < 220/120 mmHg if tPA ineligible
Target SBP < 160 mmHg after endovascular therapy
Glucose
Target serum glucose 140-180 mg/dL
References
Smith M, Reddy U, Robba C, et al. Acute ischaemic stroke: challenges for the intensivist. Intensive Care Med. 2019; epub ahead of print.
