Intracerebral hemorrhage in ICU: is it worth treating?

摘要: Methods Electronic survey of 22 items including two case-based scenarios; endorsed by SCCM (9,000 recipients) and ESICM (on-line newsletter) in 2013. A sample size of 370 was calculated based on a population of 10,000 physician members, a 5% margin error, and 95% confidence interval. We summarized results using descriptive statistics (proportions with 95% confidence intervals). A chi-square test was used to compare proportions of responses between NIs and OIs with a significance p< 0.05.Results There were 655 responders (66% completion rate); 422 (65%) were classified as OIs and 226 (35%) as NIs. More NIs follow hemodynamic protocols for neurocritically-ill patients (56% vs. 43%, p 0.001), in TBI (44.5% vs. 33.3%, p 0.007), and in SAH (38.1% vs. 21.3%, p< 000.1). For delayed cerebral ischemia (DCI), more NIs target cardiac index (CI)(35% vs. 21%, p 0.0001), and fluid responsiveness (62% vs. 53%, p 0.03), use more bedside ultrasound (BUS)(42% vs. 29%, p 0.005) and arterial waveform analysis (40% vs. 29%, p 0.02). For DCI neuromonitoring, NIs use more angiography (57% vs. 43%, p 0.004), TCD (46% vs. 38%, p 0.0001), and CTP (32% vs. 16%, p 0.0001). For CPP optimization in TBI, NIs use more arterial waveform analysis (45% vs. 35%, p 0.019), and BUS (37% vs. 27.7%, p 0.023), while more OIs monitor mixed venous oxygen saturation (54.1% vs. 45%, p 0.045). For TBI neuromonitoring, NIs use more PbtO2 (28% vs. 10%, p 0.0001). In the case scenario of raised ICP/low PbtO2, most employ analgosedation (47%) and osmotherapy (38%). Fewer make use of preserved pressure reactivity, particularly OIs …