Stroke treatment and outcome in ICU

Introduction and methods

There is no general agreement about the opportunity of ICU admission of patients with severe stroke due to high morbidity and mortality. In order to clarify the therapeutic perspective of these patients, is essential to identify some elements that could give early prognostic information. Aim of the present study was to analyze patients with severe stroke admitted to our ICU in order to assess the indications of ICU admission, prognostic value of SAPS II, morbidity and mortality. Clinical sheet of stroke patients admitted to ICU from 15 January 1995 to 31 December 2000 were retrospectively analyzed obtaining the following data: cause of admission, SAPS II, length of stay and mortality in ICU. SAPS II has been related to outcome. (Student's t-test).

Results and discussion

Twenty-seven patients were studied: 16(59.3%) had intracerebral hemorrhage (ICH), 5(18.5%) had subarachnoid hemorrage (SAH), and 6(22.2%) had an ischemic stroke (IS). The necessity of tracheal intubation and mechanical ventilation was the leading cause of admission in ICU. Mean length of mechanical ventilation was 5 ± 2 days. Mean length of stay in ICU was 7 ± 2 days. Mortality rate was 59.25%. Relationship between mortality, functional outcome and nature of stroke, is shown in Table 1. SAPS II on admission was significantly higher (P < 0.001) in non survivors. The relationship between expected and observed mortality, in patients with ICH and IS, is shown in Figure 1. We have noted a similar course of observed and expected mortality, although observed mortality was slightly higher than the expected one. We conclude that although high incidence of poor outcome in severe stroke patients admitted to ICU, a good functional outcome is possible in survivors. Moreover the SAPS II may allow a prognostic evaluation of patients on admission.

Figure 1

Table 1