A Moving Target: Blood Pressure in Neurocritical Care-A Moving Target

Video Transcription

Video Summary

The webcast "A Moving Target: Blood Pressure in Neurocritical Care" discusses evidence-based management of blood pressure (BP) in neurocritical conditions including intracerebral hemorrhage (ICH), acute ischemic stroke, and traumatic brain injury (TBI). For spontaneous ICH, early intensive BP reduction to a systolic of 130-150 mmHg is recommended to limit hematoma expansion and improve outcomes, but overly rapid decreases or aggressive targets may cause ischemia or renal injury, especially in severe hypertension and kidney disease. Nicardipine and clevidipine are preferred antihypertensives due to rapid onset, short duration, and titratability, minimizing BP variability, while labetalol is used adjunctively. In acute ischemic stroke patients undergoing mechanical thrombectomy, guidelines advise maintaining systolic BP less than 180 mmHg post-procedure to prevent hemorrhagic transformation; intensive lowering below 140 mmHg has not shown benefit and may worsen outcomes. BP targets may be individualized based on reperfusion status and hemorrhagic complications. For TBI, prevention of hypotension is critical, with recommended systolic BP targets over 110 mmHg in younger adults, focusing on cerebral perfusion pressure (CPP) of 60-70 mmHg guided by multimodal monitoring assessing autoregulation. Vasopressors like norepinephrine or phenylephrine are used to manage BP, choice dictated by patient factors and institutional protocols. Overall, individualized, carefully titrated BP management balancing cerebral perfusion and hemorrhage risk is essential for optimizing neurologic outcomes.

Keywords

blood pressure management

neurocritical care

intracerebral hemorrhage

acute ischemic stroke

traumatic brain injury

nicardipine

clevidipine

mechanical thrombectomy

cerebral perfusion pressure

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