Critical Care After Stroke

Stroke is a major cause of mortality and the leading cause of long-term disability. Critical care is crucial for increasing short-term survival and improving long-term functional outcomes in patients with intracerebral hemorrhage (ICH), and in acute ischemic stroke (AIS) patients with large hemispheric or posterior circulation strokes affecting the level of consciousness. Management of critically ill stroke patients requires a multidisciplinary care approach. Recent advances in the use of acute reperfusion therapies in acute ischemic stroke, including the increasing use of IV thrombolysis and endovascular therapy, have resulted in an increased level of complexity in acute care decision-making and post-intervention care. Similarly, new avenues for therapeutic interventions in ICH are emerging, such as surgical hematoma evacuation and intraventricular thrombolysis. As acute therapies are evolving and their availability is expanding, the critical care needs of stroke patients are similarly adapting and transforming. Innovative invasive and non-invasive monitoring strategies as well as management approaches of stroke patients with early neurological deterioration with or without preceding intervention are needed. Systems of care are adapting in order to accommodate the increasing need for timely and cost-effective access to neuro-critical care expertise and resources. The increasing sophistication of life-saving interventions in the immediate post-stroke period has prompted the need for the development of clinical decision-making tools to aid in long-term prognostication and raises issues of futility, quality of life, and end-of-life care. Lastly, during times of strains on health care systems, such as during the COVID-19 pandemic, appropriate critical care resource use for stroke patients is of particular importance.

In this Research Topic, we will explore contemporary critical care issues in stroke. Specifically, this Research Topic welcomes articles on:
• Prediction and management of complications after ICH or AIS (with or without reperfusion therapies) in the intensive care unit (ICU)
• Critical care unit monitoring and interventions after stroke
• Critical care resource utilization in stroke critical care
• End-of-life care decision making in the ICU after ICH and AIS
• Training and continued medical education in stroke critical care

We will consider articles of different types, including Original Research articles, Systematic Review articles, literature or topical Review articles, and Perspectives and Opinions. We encourage submissions of observational and interventional studies. We will not include basic science research or Case Reports. All submissions should have a direct link to clinical care delivery.