Abstract TMP87: Non-Invasive Respiratory Impedance Enhances Cerebral Perfusion in Acute Stroke Patients

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Christopher G Favilla ◽  
Rodrigo M Forti ◽  
Ahmad Zamzam ◽  
John A Detre ◽  
Michael T Mullen ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Cerebral Perfusion ◽  
Respiratory Impedance ◽  
Stroke Patients ◽  
Non Invasive

Influence of inspiration:expiration ratio on intracranial and cerebral perfusion pressure in acute stroke patients

2002 ◽  
Vol 28 (8) ◽  
pp. 1089-1093 ◽  
Author(s):  
Dimitrios Georgiadis ◽  
Stefan Schwarz ◽  
Rainer Kollmar ◽  
Ralf W. Baumgartner ◽  
Stefan Schwab
Keyword(s):  
Acute Stroke ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Stroke Patients

Abstract WP432: Non-invasive Respiratory Impedance Enhances Cerebral Perfusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Christopher G Favilla ◽  
Ashwin B Parthasarathy ◽  
John A Detre ◽  
Michael T Mullen ◽  
Scott E Kasner ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Flow Velocity ◽  
Cerebral Perfusion ◽  
Respiratory Impedance ◽  
Mean Flow ◽  
Non Invasive ◽  
End Tidal ◽  
High Level ◽  
Mean Flow Velocity

Background: Optimization of cerebral blood flow is the cornerstone of clinical management in a number of neurologic diseases, most notably ischemic stroke. Intra-thoracic pressure influences cardiac output and has the potential to impact cerebral blood flow (CBF). Here we aim to quantify cerebral hemodynamic changes in response to increased respiratory impedance using a non-invasive respiratory device. Methods: Cerebral perfusion was measured under varying levels of respiratory impedance (6cm H 2 0, 9cm H 2 0, and 12 cm H 2 0) in 20 healthy volunteers. Simultaneous measurements of microvascular CBF and middle cerebral artery mean flow velocity (MFV), respectively, were performed with optical diffuse correlation spectroscopy (DCS) and transcranial Doppler ultrasound (TCD). Results: At the high level of respiratory impedance, mean flow velocity increased by 6.4% compared to baseline (p=0.004), but changes in cortical CBF were smaller and non-significant (Figure). Heart rate, cardiac output, respiratory rate, and end tidal CO 2 remained stable during all levels of respiratory impedance. There was small increase in mean arterial blood pressure, 1.7% (p=0.006), at the high level of respiratory impedance. In a multivariable linear regression model accounting for end tidal CO 2 and individual variability, respiratory impedance was associated with increases in both mean flow velocity (coefficient: 0.49, p<0.001) and cortical CBF (coefficient: 0.13, p<0.001). Conclusions: Manipulating intrathoracic pressure via non-invasive respiratory impedance was well tolerated and produced a small but measurable increase in cerebral perfusion in healthy individuals. Future studies in acute ischemic stroke patients with impaired cerebral autoregulation is warranted in order to assess whether respiratory impedance is feasible as a novel non-invasive therapy for stroke.

Abstract TP372: Implementation of a New Intermittent Pneumatic Compression Protocol in a Stroke Unit

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Estela Sanjuan Menendez ◽  
Katherine E Santana Roman ◽  
Carlos A Molina ◽  
Pilar Giron Espot ◽  
Marc Ribo ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Intermittent Pneumatic Compression ◽  
Stroke Patients ◽  
Duration Of Treatment ◽  
Implementation Phase ◽  
Non Invasive ◽  
Dvt Prophylaxis ◽  
Hemodynamic Variables ◽  
Work Burden

Introduction: Intermittent pneumatic compression (IPC) has demonstrated to prevent deep venous thrombosis (DVT) and improve survival in acute stroke. Objective: We aimed to implement a new IPC protocol in our non-invasive stroke unit by applying IPC in the hyperacute stroke phase. Methods: All acute stroke patients with high DVT risk and contraindication for pharmacological DVT prophylaxis received IPC treatment. In ischemic stroke patients treated with reperfusion therapies, IPC protocol was planned for 24hours; intracraneal hemorrhage (ICH) patients were treated with IPC during 72hours. Clinical and hemodynamic variables were recorded. Nurses and patients were interviewed for satisfaction with the new protocol. Results: From March to August 2015, we enrolled 132 patients: 75 male (56.4%), mean age 71+/-15 y.o., ischemic strokes 103 (79.2%). Time from admission to IPC application 102+/-375min. Duration of treatment in ischemic patients was 37+/-21hours while in ICH was 44+/-26hours. No patient presented DVT in our series. We observed 6 deaths (4.5%) and 66 patients (56.4%) presented other complications, none of them related to IPC. Only at implementation phase nurses referred a relevant work burden with the new protocol compared to classical low-weighed-heparin DVT prophylaxis. After training it only takes a mean of 6±1.5 minutes to apply the treatment. Only 3 patients (2.3%) presented discomfort, 2 of them with early IPC drop off. Conclusion: IPC treatment is feasible, safe, and comfortable for stroke patients in the hyperacute phase. It increases work burden for nurses only at the implementation phase.

scholarly journals Non-Invasive Respiratory Impedance Enhances Cerebral Perfusion in Healthy Adults

2017 ◽  
Vol 8 ◽  
Author(s):  
Christopher G. Favilla ◽  
Ashwin B. Parthasarathy ◽  
John A. Detre ◽  
Arjun G. Yodh ◽  
Michael T. Mullen ◽  
...  
Keyword(s):  
Cerebral Perfusion ◽  
Healthy Adults ◽  
Respiratory Impedance ◽  
Non Invasive

Abstract NS 4: Non-Invasive Oscillometric Blood Pressure Monitoring in tPA Treated Patients: Is Mean Arterial Pressure Associated with Patient Outcomes?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Anne W Alexandrov ◽  
Asad A Chaudhary ◽  
April Sisson ◽  
Kara Sands ◽  
Pawan Rawal ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
National Standard ◽  
Stroke Patients ◽  
Non Invasive ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Center

Background: Blood pressure (BP) parameters for management of tPA treated patients are well known among experienced stroke clinicians, and violation of systolic and diastolic BP limits have previously been shown to be associated with symptomatic intracerebral hemorrhage (sICH) in tPA treated patients. Non-invasive oscillometric BP monitoring measures a “true” mean arterial pressure (MAP), and then algorithmically defines what systolic and diastolic pressure "might" be. Because this form of BP monitoring has become the national standard, we examined the occurrence of MAP BP elevations to determine their association with sICH and treatment outcome in acute ischemic stroke patients that received systemic tPA. Methods: Two-years of consecutive systemic tPA cases were retrieved from our Stroke Center database and arterial blood pressures for the first 24 hours from time of bolus were entered from auto-recordings in our electronic medical records. Protocol violations in MAP were defined as greater than 120 mm Hg at any point in the first 24 hours from time of bolus. Off-label treatment with intravenous tPA beyond 4.5 hours from symptom onset was identified a priori as a potential counfounder to stroke outcome. Symptomatic intracerebral hemorrhage was defined as an increase in the NIHSS of ≥ 4 points. Spearman’s correlation was used to assess the relationship between MAP and post-tPA NIHSS score. Results: 191 tPA cases were identified for inclusion in the analysis with 150 (79%) receiving their tPA at our Comprehensive Stroke Center and another 41 (21%) administered as a telephone-consult supported drip and ship. Patients were 65.5±16 years of age with median admission NIHSS scores of 12 (IQR=7-17). All patients had normal CT scans or minor changes consistent with acute stroke without hypo-attenuation. A total of 77 (40%) patients experienced a MAP violation overall. There were 11 isolated systolic BP violations, 4 isolated diastolic BP violations, and 21 isolated MAP violations that were otherwise not detectable by a violation in systolic or diastolic parameters, averaging 123.3±2 mm Hg. A total of 2 (1%) sICHs occurred in the sample, and of these 1 was associated with on-label peri-treatment BP protocol violations affecting systolic, diastolic and MAP parameters. An increased reduction in post-tPA NIHSS points was significantly associated with higher MAPs (r=.92; p=.008). Conclusions: Evidence-based guidelines are silent on MAP limits, and MAP is rarely monitored clinically in tPA treated patients despite dependence on the MAP for assignment of systolic and diastolic pressures in oscillometric BP monitoring. Our findings suggest that an improved understanding of the contribution of MAP-dependent oscillometric methods to BP monitoring in acute stroke patients is warranted.

scholarly journals Non-invasive monitoring of longitudinal changes in cerebral hemodynamics in acute ischemic stroke using BOLD signal delay

2018 ◽  
Vol 40 (1) ◽  
pp. 23-34 ◽  
Author(s):  
Ahmed A Khalil ◽  
Kersten Villringer ◽  
Vivien Filleböck ◽  
Jiun-Yiing Hu ◽  
Andrea Rocco ◽  
...  
Keyword(s):  
Cerebral Perfusion ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Time Shift ◽  
Lesion Volume ◽  
Bold Signal ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Non Invasive ◽  
Over Time

Relative delays in blood-oxygen-level-dependent (BOLD) signal oscillations can be used to assess cerebral perfusion without using contrast agents. However, little is currently known about the utility of this method in detecting clinically relevant perfusion changes over time. We investigated the relationship between longitudinal BOLD delay changes, vessel recanalization, and reperfusion in 15 acute stroke patients with vessel occlusion examined within 24 h of symptom onset (D0) and one day later (D1). We created BOLD delay maps using time shift analysis of resting-state functional MRI data and quantified perfusion lesion volume changes (using the D1/D0 volume ratio) and severity changes (using a linear mixed model) over time. Between baseline and follow-up, BOLD delay lesions shrank (median D1/D0 ratio = 0.2, IQR = 0.03–0.7) and BOLD delay severity decreased (b = −4.4 s) in patients with recanalization, whereas they grew (median D1/D0 ratio = 1.47, IQR = 1.1–1.7) and became more severe (b = 4.3 s) in patients with persistent vessel occlusion. Clinically relevant changes in cerebral perfusion in early stroke can be detected using BOLD delay, making this non-invasive method a promising option for detecting tissue at risk of infarction and monitoring stroke patients following recanalization therapy.

scholarly journals The Potential Roles of18F-FDG-PET in Management of Acute Stroke Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-14 ◽  
Author(s):  
Adomas Bunevicius ◽  
Hong Yuan ◽  
Weili Lin
Keyword(s):  
Acute Stroke ◽  
Fdg Pet ◽  
Time Window ◽  
Clinical Settings ◽  
Stroke Patients ◽  
Cellular Mechanisms ◽  
Fdg Uptake ◽  
Non Invasive ◽  
Wide Availability ◽  
Human Stroke

Extensive efforts have recently been devoted to developing noninvasive imaging tools capable of delineating brain tissue viability (penumbra) during acute ischemic stroke. These efforts could have profound clinical implications for identifying patients who may benefit from tPA beyond the currently approved therapeutic time window and/or patients undergoing neuroendovascular treatments. To date, the DWI/PWI MRI and perfusion CT have received the most attention for identifying ischemic penumbra. However, their routine use in clinical settings remains limited. Preclinical and clinical PET studies with [18F]-fluoro-2-deoxy-D-glucose (18F-FDG) have consistently revealed a decreased18F-FDG uptake in regions of presumed ischemic core. More importantly, an elevated18F-FDG uptake in the peri-ischemic regions has been reported, potentially reflecting viable tissues. To this end, this paper provides a comprehensive review of the literature on the utilization of14C-2-DG and18F-FDG-PET in experimental as well as human stroke studies. Possible cellular mechanisms and physiological underpinnings attributed to the reported temporal and spatial uptake patterns of18F-FDG are addressed. Given the wide availability of18F-FDG in routine clinical settings,18F-FDG PET may serve as an alternative, non-invasive tool to MRI and CT for the management of acute stroke patients.

The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽  
1999 ◽  
Vol 12 (1) ◽  
pp. 21-27
Author(s):  
Marit Kirkevold
Keyword(s):  
Acute Stroke ◽  
Theoretical Perspective ◽  
Stroke Patients ◽  
Role Of Nursing ◽  
Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

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