ArticleBMC neurology2025
Variations in the clinical practice of blood pressure and sedo-analgesia management for intracerebral hemorrhage: a case-based survey of Chinese healthcare workers.
Article in BMC neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBlood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH) is critical to improving patient prognosis. Besides routine antihypertensive medications, sedo-analgesia (i.e., a combination of sedation and analgesia) can enhance BP control during the acute phase. Nevertheless, the optimal approach remains elusive. The understanding of the evidence base and its application by healthcare practitioners significantly impact patient outcomes, yet studies on this topic are limited. Therefore, the aim of this study was to investigate the practice patterns and beliefs regarding BP management and sedo-analgesia among Chinese healthcare practitioners through questionnaires.
methodsAn anonymous online questionnaire focused on emergency treatments was developed based on four ICH patient scenarios, followed by a cross-sectional survey among Chinese healthcare practitioners using purposive sampling. Respondents were instructed to record their treatment plan and goals based on clinical examination of the patients. Chi-square tests and Mann-Whitney U tests were employed to compare differences in emergency management choices.
resultsBetween December 2021 and February 2022, 263 practitioners from the China Neurocritical Study Group were invited to participate, with 220 valid questionnaires returned, yielding an 83.7% response rate. Respondents included 123 doctors (55.9%) and 97 nurses (44.1%). Among ICH patients with elevated BP (cases 1, 3, and 4), 90.0-97.3% of respondents selected early intensive BP-lowering treatment, with urapidil as the preferred choice, targeting an upper limit of 150 mmHg. In case 2 with a BP of < 120 mmHg, 84/220 (38.2%) preferred to raise BP to 120-140 mmHg. Moreover, analgesia and sedation were selected by 74.1-94.1% and 72.3-95.0% of respondents, respectively. However, the selection of sedation targets varied significantly with respect to occupations and specialties, with critical care physicians preferring moderate sedation (Richmond Agitation and Sedation Scale -3 or below), especially in Case 2.
conclusionChinese healthcare practitioners in the neurology or critical care units are generally aware of the management of BP and sedo-analgesia in patients with ICH and can select appropriate medications and treatment goals. However, the opinions of health practitioners on BP and sedo-analgesia management goals for non-hypertensive ICH patients are conflicting, highlighting the need for additional evidence-based research to support clinical decision-making.
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