Neurocritical Care最新文献

{"title":"Proceedings of the Sixth Regional Neurocritical Care Meeting in the Middle East and Africa in Conjunction with the Kuwait 12th Critical Care Conference.","authors":"","doi":"10.1007/s12028-025-02211-6","DOIUrl":"10.1007/s12028-025-02211-6","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"742-745"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Based Prediction of Imminent ICP Insults During Neurocritical Care of Traumatic Brain Injury.","authors":"Peter Galos, Ludvig Hult, Dave Zachariah, Anders Lewén, Anders Hånell, Timothy Howells, Thomas B Schön, Per Enblad","doi":"10.1007/s12028-024-02119-7","DOIUrl":"10.1007/s12028-024-02119-7","url":null,"abstract":"<p><strong>Background: </strong>In neurointensive care, increased intracranial pressure (ICP) is a feared secondary brain insult in traumatic brain injury (TBI). A system that predicts ICP insults before they emerge may facilitate early optimization of the physiology, which may in turn lead to stopping the predicted ICP insult from occurring. The aim of this study was to evaluate the performance of different artificial intelligence models in predicting the risk of ICP insults.</p><p><strong>Methods: </strong>The models were trained to predict risk of ICP insults starting within 30 min, using the Uppsala high frequency TBI dataset. A restricted dataset consisting of only monitoring data were used, and an unrestricted dataset using monitoring data as well as clinical data, demographic data, and radiological evaluations was used. Four different model classes were compared: Gaussian process regression, logistic regression, random forest classifier, and Extreme Gradient Boosted decision trees (XGBoost).</p><p><strong>Results: </strong>Six hundred and two patients with TBI were included (total monitoring 138,411 h). On the task of predicting upcoming ICP insults, the Gaussian process regression model performed similarly on the Uppsala high frequency TBI dataset (sensitivity 93.2%, specificity 93.9%, area under the receiver operating characteristic curve [AUROC] 98.3%), as in earlier smaller studies. Using a more flexible model (XGBoost) resulted in a comparable performance (sensitivity 93.8%, specificity 94.6%, AUROC 98.7%). Adding more clinical variables and features further improved the performance of the models slightly (XGBoost: sensitivity 94.1%, specificity of 94.6%, AUROC 98.8%).</p><p><strong>Conclusions: </strong>Artificial intelligence models have potential to become valuable tools for predicting ICP insults in advance during neurointensive care. The fact that common off-the-shelf models, such as XGBoost, performed well in predicting ICP insults opens new possibilities that can lead to faster advances in the field and earlier clinical implementations.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"387-397"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic Nerve Sheath Diameter Sonography for the Diagnosis of Increased Intracranial Pressure in Nontraumatic Neurocritically Ill Patients: a Diagnostic Accuracy Systematic Review and Meta-Analysis.","authors":"Rafael Hortêncio Melo, Luciana Gioli-Pereira, Fábio Santana Machado, Chiara Robba","doi":"10.1007/s12028-025-02249-6","DOIUrl":"https://doi.org/10.1007/s12028-025-02249-6","url":null,"abstract":"<p><strong>Background: </strong>Optic nerve sheath diameter (ONSD) assessed by ultrasound is a feasible bedside method for increased intracranial pressure (IICP) diagnosis. However, most of the evidence relies on the population of patients with traumatic brain injury, with few data available on other populations. Consequently, its efficacy in nontraumatic critically ill patients remains underexplored. Our purpose was to examine the accuracy of ONSD ultrasonography for diagnosing IICP in nontraumatic neurocritically ill patients.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Embase, and the Cochrane Library databases for comparative studies of adult nontraumatic critically ill patients that evaluated the accuracy of sonographic ONSD for IICP diagnosis compared with invasive or noninvasive reference standards. Two reviewers independently completed the search, data abstraction, and quality assessment with Quality Assessment of Diagnostic Accuracy Studies-2 tool. Heterogeneity was examined with I² statistics. We used a bivariate model of random effects to summarize pooled diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary receiver operating characteristic.</p><p><strong>Results: </strong>We included 18 observational studies, comprising 1,484 patients. Etiology of IICP was mixed, being composed of central nervous system infection, intracranial hemorrhage, acute ischemic stroke, aneurysmal subarachnoid hemorrhage, idiopathic intracranial hypertension, and hypoxic-ischemic brain injury. The pooled diagnostic odds ratio was 44.7 (95% confidence interval [CI] 22.5-80.1). Pooled sensitivity and specificity were 0.92 (95% CI 0.85-0.95) and 0.90 (95% CI 0.84-0.94), respectively, with a positive likelihood ratio of 6.19 (95% CI 4.4-8.5), and a negative likelihood ratio of 0.148 (95% CI 0.09-0.22). Summary receiver operating characteristic showed a calculated area under the curve of 0.925 (95% CI 0.84-0.927). Subgroup analysis of invasive and noninvasive reference standards showed similar accuracy of ultrasound ONSD for IICP diagnosis.</p><p><strong>Conclusions: </strong>Ultrasound ONSD may be a potentially useful noninvansive tool for IICP diagnosis in patients with nontraumatic brain injury.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semiautomated Hemorrhage Volume Quantification in Aneurysmal Subarachnoid Hemorrhage.","authors":"Sebastian Sanchez, Jacob M Miller, Matthew T Jones, Rishi R Patel, Elena Sagues, Carlos Dier, Andres Gudino, Navami Shenoy, Ariel Vargas-Sanchez, Edgar A Samaniego","doi":"10.1007/s12028-024-02123-x","DOIUrl":"10.1007/s12028-024-02123-x","url":null,"abstract":"<p><strong>Background: </strong>The volume of hemorrhage is a crucial factor in predicting outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Although grading scales such as the Fisher score are widely used, they can lead to inaccuracies in quantifying the total blood volume because of their reliance on visual assessment. We analyzed a large cohort of patients with aSAH with a semiautomated software for the precise quantification of hemorrhage volume. The primary aim is to identify clear thresholds that correlate with the likelihood of complications after aSAH, thereby enhancing the predictive accuracy and improving patient management strategies.</p><p><strong>Methods: </strong>A semiautomated algorithm was developed to analyze noncontrast computed tomography scans of patients with aSAH. The algorithm categorized tissues into blood, gray matter, white matter, and cerebrospinal fluid, isolating the blood for volume quantification. Receiver operating curve analysis was done to establish thresholds for vasospasm, acute hydrocephalus, shunt-dependent hydrocephalus (SDHC), and death within 7 days.</p><p><strong>Results: </strong>A total of 500 patients with aSAH and their respective aneurysms were analyzed. Hemorrhage volume was significantly higher in patients with vasospasm (21.7 [10.9-41.4] vs. 10.7 [4.2-26.9], p < 0.001), acute hydrocephalus (22.7 [9.2-41.8] vs. 5.1 [2.1-13.5], p < 0.001), SDHC (23.8 [11.3-40.7] vs. 11.7 [4.1-28.2], p < 0.001), and those who died before 7 days (52.8 [34.6-90.6] mL vs. 14.8 [5.0-32.4] mL, p < 0.001) compared with their counterparts. Notably, specific hemorrhage thresholds were identified for each complication: 15.16 mL for vasospasm (65% sensitivity and 60% specificity), 9.95 mL for acute hydrocephalus (74% sensitivity and 69% specificity), 16.76 mL for SDHC (63% sensitivity and 60% specificity), and 33.84 mL for death within 7 days (79% sensitivity and 77% specificity).</p><p><strong>Conclusions: </strong>Semiautomated blood volume quantification tools could aid in stratifying complication risk after aSAH. Established thresholds for hemorrhage volume related to complications could be used in clinical practice to aid in management decisions.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"419-427"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations in Regional Brain Microcirculation in Patients with Sepsis: A Prospective Study Using Contrast-Enhanced Brain Ultrasound.","authors":"Duc Nam Nguyen, Luc Huyghens, Truc Mai Nguyen, Marc Diltoer, Joop Jonckheer, Wilfried Cools, Lotte Segers, Johan Schiettecatte, Jean-Louis Vincent","doi":"10.1007/s12028-024-02117-9","DOIUrl":"10.1007/s12028-024-02117-9","url":null,"abstract":"<p><strong>Background: </strong>Alterations in regional brain microcirculation have not been well studied in patients with sepsis. Regional brain microcirculation can be studied using contrast-enhanced brain ultrasound (CEUS) with microbubble administration.</p><p><strong>Methods: </strong>CEUS was used to assess alterations in regional brain microcirculation on 3 consecutive days in 58 patients with sepsis and within 24 h of intensive care unit admission in 10 aged-matched nonseptic postoperative patients. Time-intensity perfusion curve variables (time-to-peak and peak intensity) were measured in different regions of interest of the brain parenchyma. The mean arterial pressure, cardiac index (using transthoracic echocardiography), global cerebral blood flow (using echo-color Doppler of the carotid and vertebral arteries), mean flow velocities of the middle cerebral arteries, and brain autoregulation (using transcranial echo-color Doppler) were measured simultaneously. The presence of structural brain injury in patients with sepsis was confirmed on computed tomography imaging, and encephalopathy, including coma and delirium, was evaluated using the Glasgow Coma Scale and the Confusion Assessment Method in the Intensive Care Unit.</p><p><strong>Results: </strong>Of the 58 patients with sepsis, 42 (72%) developed acute encephalopathy and 11 (19%) had some form of structural brain injury. Brain autoregulation was impaired in 23 (40%) of the patients with sepsis. Brain microcirculation alterations were observed in the left lentiform nucleus and left white matter of the temporoparietal region of the middle cerebral artery in the sepsis nonsurvivors but not in the survivors or postoperative patients. The alterations were characterized by prolonged time-to-peak (p < 0.01) and decreased peak intensity (p < 0.01) on the time-intensity perfusion curve. Prolonged time-to-peak but not decreased peak intensity was independently associated with worse outcome (p = 0.03) but not with the development of encephalopathy (p = 0.77).</p><p><strong>Conclusions: </strong>Alterations in regional brain microcirculation are present in critically ill patients with sepsis and are associated with poor outcome. Trial registration Registered retrospectively on December 19, 2019.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"428-439"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifying the Apnea Test to Minimize Complications.","authors":"Summit Dev Bloria","doi":"10.1007/s12028-024-02179-9","DOIUrl":"10.1007/s12028-024-02179-9","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"741"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal Nicardipine After Aneurysmal Subarachnoid Hemorrhage: A Scoping Review.","authors":"Jared F Sweeney, John Chen, Bassem Darwish, Devin Holden, Erin Barnes, Panayiotis Varelas","doi":"10.1007/s12028-024-02175-z","DOIUrl":"10.1007/s12028-024-02175-z","url":null,"abstract":"<p><p>Intrathecal nicardipine (ITN) is an investigational therapy for cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). The objective of this scoping review was to characterize the current state of the literature and map the current available evidence, examine research methodology, clarify key concepts and definitions in the literature, report procedural characteristics, identify and analyze knowledge gaps, and serve as a precursor for future systematic reviews, meta-analyses, and randomized controlled trials. An electronic search for studies on ITN for the treatment of CVS and DCI in patients with aSAH was conducted in accordance with published standards. A total of 390 studies were identified by the search. After inclusion criteria were applied, 20 studies were identified for analysis. The identified studies included a total of 976 patients with aSAH who received ITN for the treatment of CVS and DCI. One randomized controlled trial, two prospective observational studies, nine retrospective observational studies, seven retrospective case series, and one case report met inclusion criteria. Study designs, drug administration, dosing regimens, drug concentrations, pharmacokinetics, patient selection, duration of therapy, outcome measures, adverse event monitoring, and definitions of CVS and DCI used are synthesized and discussed. Despite advances in the care of patients with aSAH, CVS and DCI remain leading causes of morbidity and mortality, and ITN represents a potential therapy to help prevent and treat this disease process. With one published randomized controlled trial on one method of administration, one trial underway on a second method of administration, and numerous heterogeneous and primarily retrospective studies published to date, future study with an emphasis on homogenizing study design and outcomes measured is needed to better understand this potential therapy.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"595-609"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative and Radiological Assessment of Post-cardiac-Arrest Comatose Patients with Diffusion-Weighted Magnetic Resonance Imaging.","authors":"Sam Van Roy, Liangge Hsu, Joseph Ho, Benjamin M Scirica, David Fischer, Samuel B Snider, Jong Woo Lee","doi":"10.1007/s12028-024-02087-y","DOIUrl":"10.1007/s12028-024-02087-y","url":null,"abstract":"<p><strong>Background: </strong>Although magnetic resonance imaging, particularly diffusion-weighted imaging, has increasingly been used as part of a multimodal approach to prognostication in patients who are comatose after cardiac arrest, the performance of quantitative analysis of apparent diffusion coefficient (ADC) maps, as compared to standard radiologist impression, has not been well characterized. This retrospective study evaluated quantitative ADC analysis to the identification of anoxic brain injury by diffusion abnormalities on standard clinical magnetic resonance imaging reports.</p><p><strong>Methods: </strong>The cohort included 204 previously described comatose patients after cardiac arrest. Clinical outcome was assessed by (1) 3-6 month post-cardiac-arrest cerebral performance category and (2) coma recovery to following commands. Radiological evaluation was obtained from clinical reports and characterized as diffuse, cortex only, deep gray matter structures only, or no anoxic injury. Quantitative analyses of ADC maps were obtained in specific regions of interest (ROIs), whole cortex, and whole brain. A subgroup analysis of 172 was performed after eliminating images with artifacts and preexisting lesions.</p><p><strong>Results: </strong>Radiological assessment outperformed quantitative assessment over all evaluated regions (area under the curve [AUC] 0.80 for radiological interpretation and 0.70 for the occipital region, the best performing ROI, p = 0.011); agreement was substantial for all regions. Radiological assessment still outperformed quantitative analysis in the subgroup analysis, though by smaller margins and with substantial to near-perfect agreement. When assessing for coma recovery only, the difference was no longer significant (AUC 0.83 vs. 0.81 for the occipital region, p = 0.70).</p><p><strong>Conclusions: </strong>Although quantitative analysis eliminates interrater differences in the interpretation of abnormal diffusion imaging and avoids bias from other prediction modalities, clinical radiologist interpretation has a higher predictive value for outcome. Agreement between radiological and quantitative analysis improved when using high-quality scans and when assessing for coma recovery using following commands. Quantitative assessment may thus be more subject to variability in both clinical management and scan quality than radiological assessment.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"541-550"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision-Making for Patients with Stroke in Neurocritical Care: A Qualitative Meta-Synthesis.","authors":"Hui Zhang, Carmel Davies, Diarmuid Stokes, Deirdre O'Donnell","doi":"10.1007/s12028-024-02106-y","DOIUrl":"10.1007/s12028-024-02106-y","url":null,"abstract":"<p><p>Decision-making for patients with stroke in neurocritical care is uniquely challenging because of the gravity and high preference sensitivity of these decisions. Shared decision-making (SDM) is recommended to align decisions with patient values. However, limited evidence exists on the experiences and perceptions of key stakeholders involved in SDM for neurocritical patients with stroke. This review aims to address this gap by providing a comprehensive analysis of the experiences and perspectives of those involved in SDM for neurocritical stroke care to inform best practices in this context. A qualitative meta-synthesis was conducted following the methodological guidelines of the Joanna Briggs Institute (JBI), using the thematic synthesis approach outlined by Thomas and Harden. Database searches covered PubMed, CIHAHL, EMBASE, PsycINFO, and Web of Science from inception to July 2023, supplemented by manual searches. After screening, quality appraisal was performed using the JBI Appraisal Checklist. Data analysis comprised line-by-line coding, development of descriptive themes, and creation of analytical themes using NVivo 12 software. The initial search yielded 7,492 articles, with 94 undergoing full-text screening. Eighteen articles from five countries, published between 2010 and 2023, were included in the meta-synthesis. These studies focused on the SDM process, covering life-sustaining treatments (LSTs), palliative care, and end-of-life care, with LST decisions being most common. Four analytical themes, encompassing ten descriptive themes, emerged: prognostic uncertainty, multifaceted balancing act, tripartite role dynamics and information exchange, and influences of sociocultural context. These themes form the basis for a conceptual model offering deeper insights into the essential elements, relationships, and behaviors that characterize SDM in neurocritical care. This meta-synthesis of 18 primary studies offers a higher-order interpretation and an emerging conceptual understanding of SDM in neurocritical care, with implications for practice and further research. The complex role dynamics among SDM stakeholders require careful consideration, highlighting the need for stroke-specific communication strategies. Expanding the evidence base across diverse sociocultural settings is critical to enhance the understanding of SDM in neurocritical patients with stroke.Trial registration This study is registered with PROSPERO under the registration number CRD42023461608.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"644-667"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Related to Nonachievement of Intensive Blood Pressure-Lowering Target in Patients with Intracerebral Hemorrhage.","authors":"Daniel Vázquez-Justes, Miriam Paul-Arias","doi":"10.1007/s12028-024-02092-1","DOIUrl":"10.1007/s12028-024-02092-1","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracerebral hemorrhage (ICH) is one of the most disabling forms of stroke. Intensive lowering of blood pressure (BP) has been postulated as one of the therapies that can improve functional outcomes. However, this intensive reduction is not always achieved. We aimed to study the differences between patients in whom intensive BP lowering was achieved during the first 24 h after admission and those in whom this BP lowering was not possible.</p><p><strong>Methods: </strong>We retrospectively reviewed medical charts to obtain information on BP management during the first 24 h. Our protocol establishes that intensive BP lowering below 140 mm Hg of systolic BP should be pursued.</p><p><strong>Results: </strong>In total, 210 patients were included. In 107 (51.0%), an intensive target BP was not achieved. This group of patients had higher initial National Institutes of Health Stroke Scale scores and poorer clinical evolution, with more early neurological deterioration, higher requirements for antihypertensive treatment, higher necessity for surgical evacuation, more withdrawal of life-sustaining therapies, and higher mortality at 3 months (all p < 0.05). In the multivariable analysis, high BP levels at admission remained related to the nonachievement of BP-lowering goals, despite a higher administration of antihypertensive medications.</p><p><strong>Conclusions: </strong>In this study, the intensive BP-lowering goal was not achieved in about half of the patients with ICH, despite the high proportion of patients receiving antihypertensive medications. This group of patients had poorer outcomes and higher mortality rates at 3 months. High BP at presentation may be difficult to control in patients with high clinical severity of ICH despite aggressive management.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"495-501"},"PeriodicalIF":3.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}