22. European Stroke Conference 680 Acute stroke: clinical patterns and practice Views of health professionals on methods to reduce removal of nasogastric tubes after acute stroke J.R. Beavan1, R. Wells2 Royal Derby Hospital, Derby, UNITED KINGDOM1, Royal Derby Hospital, Derby, UNITED KINGDOM2 Background 50% of patients following acute stroke have dysphagia and a proportion of these will require na-sogastric tube (NGT) feeding. Frequent removal of tubes is the most common reason for failure of feeding. A number of methods may be used to reduce this (e.g. nasal tape, bridles, mittens), but there is controversy about the best and most ethical methods to use when patients frequently lack capacity to take part in these decisions. Methods Combined methods of UK web based questionnaire survey and conference questionnaire to clini-cians involved in stroke unit care. Results There were 126 (98 web based) responses. 71% of respondents were doctors. Less than half had inserted an NGT in the last 5 years. The most common methods seen in practice were sticky tape, followed by nasal bridle and mittens. 39% had a policy related to methods to prevent removal of NGTs, of which some were part of a hospital restraint policy. Opinions differed about which meth-ods constituted restraint. 35% thought practice in the UK had changed since the Mental Capacity Act 2005 UK. Comments on nasogastric tube feeding suggest that this intervention is not viewed as a wholly medical procedure, unlike interventions such as urinary catheterisation. Conclusions Nasogastric tube feeding after acute stroke may be challenging due to multiple tube removals. Views of the best methods to improve the efficiency of NGT feeding may differ between professional groups, although this survey was dominated by physician views. More exploration, extension of this survey and research into this area may help guidance. 706 © 2013 S. Karger AG, Basel Scientific Programme 681 Acute stroke: clinical patterns and practice Systolic blood pressure behaviour around intravenous thrombolysis for acute ischaemic stroke: association with outcomes R. Romero-Ortuno1, B. Prendiville2, I. Noone3, G. Hughes4, M. Martin5, O. Collins6, D. O’Shea7, M. Crowe8 St Vincent’s University Hospital, Department of Medicine for the Elderly, Dublin, IRELAND1, St Vincent’s University Hospital, Department of Medicine for the Elderly, Dublin, IRELAND2, St Vincent’s University Hospital, Department of Medicine for the Elderly, Dublin, IRELAND3, St Vincent’s University Hospital, Department of Medicine for the Elderly, Dublin, IRELAND4, St Vincent’s University Hospital, Department of Medicine for the Elderly, Dublin, IRELAND5, St Vincent’s University Hospital, Department of Medicine for the Elderly, Dublin, IRELAND6, St Vincent’s University Hospital, Department of Medicine for the Elderly, Dublin, IRELAND7, St Vin-cent’s University Hospital, Department of Medicine for the Elderly, Dublin, IRELAND8 Background Recent literature has suggested that high systolic blood pressure (SBP) during intravenous throm-bolysis with recombinant tissue plasminogen activator (rtPA) may be associated with poor outcomes in patients with acute ischaemic stroke. We studied this association in our clinical practice. Methods We reviewed the charts of all patients undergoing rtPA in our service between June 2009 and De-cember 2012. We collected all nurse-recorded SBP values within 3 hours before and after rtPA. Mean SBP values pre- and post-rtPA were calculated. Generalised linear models were computed to assess the independent contribution of mean pre- and post- SBP values towards outcomes in the presence of age, pre-stroke modified Rankin Scale (mRS), initial NIHSS score, and time from event to rtPA. The outcomes studied were: hemorrhagic transformation (HT, symptomatic or asymptomat-ic), change in NIHSS at 7 days, and change in mRS at 90 days. Results 61 patients (34 males, 27 females; mean age 68.8 years, range 31 – 92 years) underwent rtPA over the period. Their mean NIHSS score pre-rtPA was 13.5 (SD 5.7), and post-rtPA 8.2 (SD 7.0) (paired samples t-test P < 0.001). Their mean pre-stroke mRS was 0.4 (SD 0.9), and post-stroke 2.4 (SD 1.7) (P < 0.001). In two cases there was symptomatic HT (further 7 had asymptomatic HT). Mean SBP pre-rtPA was 151.9 mmHg (SD 22.8), and post 146.4 mmHg (SD 20.5) (P = 0.014). Figure 1 shows the mean SBP pre- and post-rtPA for tertiles of NIHSS improvement. In the multivariable models, there were no significant predictors of HT. Mean SBP post-rtPA was a weak predictor of changes in NIHSS (OR 1.09, P < 0.05) and mRS (OR 1.02, P = 0.05). Conclusion In our series, higher SBP post-rtPA seemed to be associated with lesser NIHSS improvement at 7 days and higher dependency at 90 days. The small effect sizes could be due to underpower. Further research is necessary to understand the determinants of blood pressure behaviour peri-thrombolysis.
Karger_ESC London_2013
To see the actual publication please follow the link above