Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting

Neurocrit Care. 2015 Dec;23(3):313-20. doi: 10.1007/s12028-015-0116-y.


Background and purpose: Patients with acute brain injuries require strict physiologic control to minimize morbidity and mortality. This study aimed to assess in-hospital compliance to strict physiologic parameters (BP, HR, ICP, SpO2) in these populations.

Methods: Patients with severe cerebrovascular events were admitted to the neurointensive care unit (NSICU) and were continuously monitored using the BedMasterEX (Excel Medical Electronics Inc, FL) system, which recorded hemodynamic data via an arterial catheter continuously in 5-s intervals. Furthermore, we investigated the impact of healthcare provider shift changes (6-8 a.m./p.m) and of day (6 a.m.-6 p.m.) versus night (6 p.m-6 a.m) shifts in hemodynamic control.

Results: Fifty patients admitted to the NSICU, 50 % male, mean age 59.7 ± 13.9 years with subarachnoid hemorrhage (23), ischemic stroke (8), subdural hematoma (4), intracerebral hemorrhage (3), intraventricular hemorrhage (2), and miscellaneous injuries (10) were enrolled. Data represented 2,337 total hours of continuous monitoring. Systolic BPs (SBP) were on average outside of recommended ranges 32.26 ± 30.46 % of the monitoring period. We subdivided adherence to ideal SBP range: optimal (≥99 % of time spent in NSICU within range) was achieved in 12 %, adequate (90 %) in 16 %, suboptimal (80 %) in 20 %, inadequate I (70 %) in 12 %, and inadequate II (<70 %) in 40 % of patients. Comparison of shift change %time and day versus night %time out of parameter yielded no statistically significant differences across SAH patients.

Conclusion: Hemodynamic management of patients with cerebrovascular injuries, based on targeted thresholds in the NSICU, yielded optimal control of SBP in only 28 % of our patients (within parameters ≥90 % of time).

Keywords: Acute brain injury; Compliance; Hemodynamic management; Neurocritical care; Physiologic parameters; Subarachnoid hemorrhage (SAH); Systolic blood pressure (SBP) parameter adherence.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Blood Pressure / physiology*
  • Brain Ischemia / physiopathology
  • Brain Ischemia / therapy*
  • Female
  • Guideline Adherence / standards*
  • Humans
  • Intensive Care Units
  • Intracranial Hemorrhages / physiopathology
  • Intracranial Hemorrhages / therapy*
  • Male
  • Middle Aged
  • Stroke / physiopathology
  • Stroke / therapy*