大面积脑梗死诊疗指南
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• 1.疼痛、焦虑、躁动者推荐给予镇静和镇痛。（强推荐，极低质 量证据）
• 2.尽可能给予最低强度的镇静治疗，尽可能尽早停止镇静治疗， 同时应保持生理学稳定，防治患者的不适感。（强推荐，极低质 量证据）
.
Are daily wake-up trials recommended?
• Wake-up trials were initially reported to be beneficial regarding reduction of ventilation duration and outcome for some ICU populations.
• 1.存在呼吸功能不全或神经功能恶化的LHI 患者应该立即气管插管。 （强推荐，极低质量证据）。
• 2.即使不能交流和配合，符合以下标准者应该尝试拔管（强推荐， 极低质量证据）：
• （1）自主呼吸试验成功 • （2）口咽部无分泌物聚集 • （3）咳嗽反射存在，插管不耐受 • （4）无镇静和镇痛
.
What is the best timing for tracheostomy in LHI?
• Dysphagia screening tests such as the gugging swallowing screen have been found useful in acute stroke patients, but patients with large or multiple strokes or rapid decline in LOC were not included. Thus, it is difficult to estimate the validity of these tests in LHI patients
• current stroke guidelines do not provide a detailed approach regarding the day-to-day management of these complicated patients
• The purpose of this guideline is to provide evidence-based recommendations for the critical care management of patients following LHI
• 对于LHI 患者，不推荐每天常规进行唤醒试验。存在ICP 危象者采 取俯卧位通气应谨慎。推荐进行神经功能监测（至少包括ICP 和 CPP）以指导镇静治疗，生理学不稳定或不舒适的患者每天唤醒 试验应避免或者延期执行。（强推荐，极低质量证据）
.
Gastrointestinal Tract
• Dysphagia affects 30–50 % of acute stroke patients.Screening for dysphagia has been reported to decrease pneumonia in the general stroke population;
• sedation and analgesia may facilitate medical goals such as lowering ICP, enabling procedures and operations, or terminating seizures
.
Should analgesia and/or sedation be administered in LHI patients? If so, which pharmacologic agents should be used?
Evidence-Based Guidelines for the Management of Large Hemispheric Infarction
The sixth affiliated hospital of KMU Wang hao 2015.05.21
.
.
• Large hemispheric infarction (LHI), also known as malignant middle cerebral infarction, is a devastating disease associated with significant disability and mortality.
• endoscopic swallowing tests，Fiberoptic endoscopic evaluation of swallowing
.
Does hyperventilation effectively treat increased ICP in LHI?
• 1.LHI 患者不应该预防性过度换气。（强推荐，极低质量证据） • 2.短期过度换气可以作为挽救脑疝的方法。（弱推荐，极低质量
证据）
.Байду номын сангаас
Analgesia and Sedation
• 拔管失败或插管后7-14 天不能拔管的LHI 患者可以考虑气管切开。 （弱推荐，低质量证据）。
.
Hyperventilation
• Hyperventilation is often employed in increased ICP to induce hypocarbia and cerebral vasoconstriction. The effect on ICP isusually seen within minutes, but it is short-lived.
.
Airway Management
•What are the indications for intubation and extubation in LHI? • What is the best timing for tracheostomy in LHI?
.
What are the indications for intubation and extubation in LHI?
• 2.尽可能给予最低强度的镇静治疗，尽可能尽早停止镇静治疗， 同时应保持生理学稳定，防治患者的不适感。（强推荐，极低质 量证据）
.
Are daily wake-up trials recommended?
• Wake-up trials were initially reported to be beneficial regarding reduction of ventilation duration and outcome for some ICU populations.
• 1.存在呼吸功能不全或神经功能恶化的LHI 患者应该立即气管插管。 （强推荐，极低质量证据）。
• 2.即使不能交流和配合，符合以下标准者应该尝试拔管（强推荐， 极低质量证据）：
• （1）自主呼吸试验成功 • （2）口咽部无分泌物聚集 • （3）咳嗽反射存在，插管不耐受 • （4）无镇静和镇痛
.
What is the best timing for tracheostomy in LHI?
• Dysphagia screening tests such as the gugging swallowing screen have been found useful in acute stroke patients, but patients with large or multiple strokes or rapid decline in LOC were not included. Thus, it is difficult to estimate the validity of these tests in LHI patients
• current stroke guidelines do not provide a detailed approach regarding the day-to-day management of these complicated patients
• The purpose of this guideline is to provide evidence-based recommendations for the critical care management of patients following LHI
• 对于LHI 患者，不推荐每天常规进行唤醒试验。存在ICP 危象者采 取俯卧位通气应谨慎。推荐进行神经功能监测（至少包括ICP 和 CPP）以指导镇静治疗，生理学不稳定或不舒适的患者每天唤醒 试验应避免或者延期执行。（强推荐，极低质量证据）
.
Gastrointestinal Tract
• Dysphagia affects 30–50 % of acute stroke patients.Screening for dysphagia has been reported to decrease pneumonia in the general stroke population;
• sedation and analgesia may facilitate medical goals such as lowering ICP, enabling procedures and operations, or terminating seizures
.
Should analgesia and/or sedation be administered in LHI patients? If so, which pharmacologic agents should be used?
Evidence-Based Guidelines for the Management of Large Hemispheric Infarction
The sixth affiliated hospital of KMU Wang hao 2015.05.21
.
.
• Large hemispheric infarction (LHI), also known as malignant middle cerebral infarction, is a devastating disease associated with significant disability and mortality.
• endoscopic swallowing tests，Fiberoptic endoscopic evaluation of swallowing
.
Does hyperventilation effectively treat increased ICP in LHI?
• 1.LHI 患者不应该预防性过度换气。（强推荐，极低质量证据） • 2.短期过度换气可以作为挽救脑疝的方法。（弱推荐，极低质量
证据）
.Байду номын сангаас
Analgesia and Sedation
• 拔管失败或插管后7-14 天不能拔管的LHI 患者可以考虑气管切开。 （弱推荐，低质量证据）。
.
Hyperventilation
• Hyperventilation is often employed in increased ICP to induce hypocarbia and cerebral vasoconstriction. The effect on ICP isusually seen within minutes, but it is short-lived.
.
Airway Management
•What are the indications for intubation and extubation in LHI? • What is the best timing for tracheostomy in LHI?
.
What are the indications for intubation and extubation in LHI?