Optimal Blood Pressure at Vasopressor Weaning in Intensive Care Units — What Are Targets of Blood Pressure Management?

2021 ◽  
Author(s):  
Zichen Wang ◽  
Luming Zhang ◽  
Wen Ma ◽  
Hao Wang ◽  
Haiyan Yin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Pressure Management ◽  
Blood Pressure Management ◽  
Optimal Blood Pressure

scholarly journals Blood Pressure Management Before, During, and After Endovascular Thrombectomy for Acute Ischemic Stroke

2021 ◽  
Vol 41 (01) ◽  
pp. 046-053
Author(s):  
Adam de Havenon ◽  
Nils Petersen ◽  
Ali Sultan-Qurraie ◽  
Matthew Alexander ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Association ◽  
Future Research ◽  
Pressure Management ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Blood Pressure Management ◽  
Clinical Scenarios ◽  
Before And After ◽  
Optimal Blood Pressure

AbstractThere is an absence of specific evidence or guideline recommendations on blood pressure management for large vessel occlusion stroke patients. Until randomized data are available, the periprocedural blood pressure management of patients undergoing endovascular thrombectomy can be viewed in two phases relative to the achievement of recanalization. In the hyperacute phase, prior to recanalization, hypotension should be avoided to maintain adequate penumbral perfusion. The American Heart Association guidelines should be followed for the upper end of prethrombectomy blood pressure: ≤185/110 mm Hg, unless post–tissue plasminogen activator administration when the goal is <180/105 mm Hg. After successful recanalization (thrombolysis in cerebral infarction [TICI]: 2b–3), we recommend a target of a maximum systolic blood pressure of < 160 mm Hg, while the persistently occluded patients (TICI < 2b) may require more permissive goals up to <180/105 mm Hg. Future research should focus on generating randomized data on optimal blood pressure management both before and after endovascular thrombectomy, to optimize patient outcomes for these divergent clinical scenarios.

scholarly journals Review of major trials of acute blood pressure management in stroke

2021 ◽  
pp. 0271678X2110043
Author(s):  
Thompson G Robinson ◽  
Jatinder S Minhas ◽  
Joseph Miller
Keyword(s):  
Blood Pressure ◽  
Clinical Trials ◽  
Acute Stroke ◽  
Trial Design ◽  
Haemorrhagic Stroke ◽  
Pressure Management ◽  
Blood Pressure Management ◽  
Multiple Trials ◽  
Hypertensive Crises ◽  
Improve Patient

Over the last two decades, there have been a number of major landmark clinical trials, classified as “major” as they sought to address clear clinical practice driven questions, in a pragmatic yet robust trial design, using a large powered sample size (n > 1000), in order to help improve patient outcome through informing guidelines. A commonality across all stroke sub-types included in these trials is the tendency to acute hypertensive crises within the acute stroke period. This phenomenon is associated with greater stroke complications and worsened overall prognosis. Multiple trials have attempted to address the issue of acute blood pressure management during the acute stroke period, with consideration for timing, magnitude of lowering, agent and relationship to other interventions. This review will consider the major clinical trials performed in ischaemic and haemorrhagic stroke that test the hypothesis that acute BP reduction improves clinical outcomes.

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