ICU care of Patients with Cerebrovascular disease in SNUH.

Abstract

In SNUH, Department of Neurology takes primary responsibility for care of ischemic and non-surgical hemorrhagic stroke patients. Dept. of Neurosurgery puts up with most of surgical hemorrhagic strokes, arteriovenous malformations, carotid artery stenosis, etc. SNUH has 28 beds in surgical ICU and medical ICU, and Depts. Of Neurosurgery and Neurology have 8 beds in base. In surgical ICU, we have 1053 patients in Neurosurgical field for the last three years. Of them, 414 patients (39.3%) had cerebrovascular diseases, and the mean stay in ICU was 6.7 days. For the management of ischemic stroke patients, ICU care is not generally required in SNUH. In hyperacute phase, when thrombolytic therapy with urokinase or r-TPA is used, and interventional injection of antithrombotic agent aided, closed observation is performed in intensive care unit. Basically, neurological, neurosurgical and interventional radiosurgical parts are involved for the effective care and protocols for acute management are developed. In hemorrhagic stroke patients, joint management is done by neurosurgical and neurological units, and the need for ICU care is determined by the patients' status. Neurosurgical part leads the care in surgically indicated patients, and neurological part supports general care or postoperative care of the patients. Basically, ICU is required in peri-operative periods. In SNUH, intensive care for stroke patients are not well organized and systemized yet, but efforts are being made for improved proto-cols and better care units. We hope for Cerebrovascular Disease Center be developed in recent period, and more systemic approach for stroke patients are anticipated.