Acute ischemic stroke patients are commonly admitted to an ICU after receiving IV tPA to be closely monitored for potential complications.
Current post-tPA protocol requires frequent vital signs and neurological assessments up to every 15 minutes, thereby requiring 1:1 or 1:2 nurse-to-patient ratio.
Studies have shown that stroke severity is a strong predictor of the need for critical care interventions for post-tPA patients, where patients with an NIHSS score ≥10 have an ~8x higher odds of requiring critical care interventions than those with NIHSS <10.
A low-intensity post-tPA monitoring protocol (Figure 1) for patients with NIHSS <10 and no critical care needs has been found to be safe in a small single center study.
These low risk patients were admitted with telemetry monitoring and 1:3 nurse-to-patient ratio after an initial period of q15 min standard monitoring.
An international, multicenter, randomized controlled trial is being planned to study this further.
This strategy may help streamline care and utilize hospital resources more efficiently in the COVID-19 pandemic and beyond.
Bottom Line: Patients with NIHSS <10 may be safe for low-intensity post-tPA monitoring if they do not require critical care after an initial period of q15 min standard monitoring for the first 2 hours.
References
Faigle R, Butler J, Carhuapoma JR, et al. Safety trial of low-intensity monitoring after thrombolysis: Optimal Post Tpa-Iv Monitoring in Ischemic STroke (OPTIMIST). Neurohospitalist. 2020;10(1):11-15.
Faigle R, Johnson B, Summers D, et al. Low-intensity monitoring after stroke thrombolysis during the COVID-19 pandemic. Neurocrit Care. 2020;33(2):333-337.
