Guideline-recommended basic parameter adherence in neurocritical care stroke patients: Observational multicenter individual participant data analysis

Abstract

Introduction: Neurocritical care patients with neurovascular disease often face poor long-term outcomes, highlighting the pivotal role of evidence-based interventions. Although International Guidelines emphasize managing basic physiological parameters like temperature, blood glucose, blood pressure, and oxygen levels, physician adherence to these targets remains uncertain. This study aimed to assess adherence to guideline-based treatment targets for basic physiological parameters in neurocritical care.

Patients and methods: This multicenter observational study was conducted across eight tertiary University Hospitals in Germany analyzed 474 patients requiring mechanical ventilation (between January 1st and December 31st, 2021). Adherence was defined as the rate of measurements within therapeutic ranges for systolic blood pressure (situation-adapted), mean blood pressure (MAP, 60-90 mmHg), glucose levels (80-180 mg/dl), body temperature (<37.5°C), partial arterial pressure of oxygen (PaO₂) 80-120 mmHg und partial arterial pressure of carbon dioxide (PaCO₂) 35-45 mmHg during the initial 96 h of hospitalization in 4 hour-intervals.

Results: Overall, 70.7% of all measurements were within the predetermined therapeutic ranges including SBP (71.3%), temperature (68.3%), MAP (71.4%), PaO₂ (65.2%), PaCO₂ (75.0%) and blood glucose (80.7%).

Discussion and conclusion: This multicenter study demonstrates adherence to guideline-based treatment targets, underscoring the high standards maintained by neurological intensive care units. Our study offers valuable insights into adherence to guideline-based treatment targets for neurocritical care patients in Germany. To improve patient care and optimize therapeutic strategies in neurovascular diseases, further research is needed to examine the impact of these adherence parameters on long-term outcomes.

Keywords: AIS; ICH; NICU; adherence; bundle.

Graphical abstract

Figure 1.

Flow chart of study participants. A total of 493 neurocritical care patients from eight tertiary University Hospitals in Germany were investigated during the period from January 1st to December 31st, 2021. Nineteen patients were excluded because of missing data. Among the 474 patients remaining, 331 were diagnosed with ischemic stroke, while 143 had hemorrhagic stroke. Clinical parameters, including systolic blood pressure, mean arterial blood pressure, body temperature, blood glucose levels, and partial arterial pressure of oxygen and carbon dioxide, were recorded upon admission and every 4 h for the initial 96 h of intensive care treatment. *Missing data consisted of: missing data documentation (>33% missing data) or availability of the 4-hour measures during the first 96 h of treatment.

Figure 2.

Median values of basic clinical parameters in 4-hours intervals during the first 96 h. AIS: acute ischemic stroke; ICH: intracerebral hemorrhage; PaO₂: partial arterial pressure of oxygen; SBP: systolic blood pressure; NICU: neurointensive care unit. Median values (IQR) for systolic blood pressure, mmHg separated for intracerebral hemorrhage and acute ischemic stroke, partial pressure of oxygen, mmHg and temperature, °C measured in 4-hours intervals since admission during the first 96 h.

Figure 3.

Adherence to guideline-based treatment targets in 4-hours intervals during the first 96 h of NICU. SBP: systolic blood pressure; MAP: mean arterial pressure; PaO₂: partial arterial pressure of oxygen; PaCO₂: partial arterial pressure of carbon dioxide; NICU: neurointensive care unit. Adherence to guideline-based treatment targets, that is, SPB, MAP, temperature, blood glucose, PaCO₂ and PaO₂ in 4-hours intervals during the first 96 h of neurocritical care treatment. Adherence is determined as the percentage (%) of measurements within the guideline-recommended range relative to the total measurements assessed within 4-hours intervals.