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Few certainties exist regarding optimal management of Blood Pressure (BP) in the very first hours after an ischemic stroke and many questions remain still unanswered. Our work aimed to evaluate the role of BP and its trend as possible determinants of in-hospital mortality (primary outcome), discharge disabilities and hospitalization length (secondary outcomes) in ischemic stroke patients presented with Hypertensive Emergencies (HE). We retrospectively evaluated patients presented to Niguarda Hospital, Emergency Department (ED), from 2015 to 2017 with a neurological ischemic HE. BP at ED presentation (T0), its management in ED (T1) and its values at the stroke unit admission (T2) were evaluated. 267 patients were included (0.13 % of all ED accesses and 17.9 % of all ischemic strokes). In the whole population, BP values were not associated with in-hospital mortality while T0 and T2 SBP result were associated to discharge disability and hospitalization length. In pre-specified subgroup analysis these associations were confirmed only in untreated subjects (not anti-hypertensive nor thrombolysis). In fact, no significant relationship can be found between BP values and any secondary outcome in thrombolysis and anti-hypertensive treated patients. BP values and its management can not be related to in-hospital mortality in stroke patients, presented with HE, while they are associated to discharge disability and hospitalization length. In subgroup analysis, results were confirmed only in untreated (not anti-hypertensive therapies nor thrombolytic). [ABSTRACT FROM AUTHOR]

The use of continuous positive airway pressure (CPAP) in COVID-19 hypoxemic respiratory failure (h-ARF) under a strict protocol has been described to be highly efficient. However, early prediction of failure is crucial to avoid delayed intubation. Lower PaCO2 values may represent a higher inspiratory effort and, therefore, may help identify patients at greatest risk of CPAP failure. Aim of this study was to observe the PaCO2 trend of COVID-19 patients with h-ARF before and after the initial treatment with helmet-CPAP. A case series study was conducted from November 2020 to March 2021. All adult patients with h-ARF secondary to COVID-19 treated with helmet-CPAP and eligible for endotracheal intubation were observed. Of a total of 54 patients, 32 (59.3%) underwent intubation. Seven (12.9%) patients died in the ETI group, and none in the non-ETI group. Median PaO2/FiO2 ratio on admission was 91mmHg [IQR 68-185] vs. 104mmHg [IQR 85-215] (p=0.137) in the ETI e non-ETI group, respectively. No differences were found either for PaCO2 values on admission (31.5mmHg [IQR 27-35] vs. 29.3mmHg [IQR 27.7-40]) and for PaCO2 variations after 120 minutes of CPAP (+2.38 mmHg ± 3.65 vs. +2.73 mmHg ± 3.96). Changes in PaCO2 values were observed during an initial helmet-CPAP trial, but no differences were found in those undergoing endotracheal intubation as compared to the others. [ABSTRACT FROM AUTHOR]

Hypertensive urgencies-emergencies are important and common events. They are defined as a severe elevation in BP, higher than 180/120 mmHg, associated or not with the evidence of new or worsening organ damage for emergencies and urgencies respectively. Anamnestic information, physical examination and instrumental evaluation determine the following management that could need oral (for urgencies) or intravenous (for emergencies) anti-hypertensives drugs. The choice of the specific drugs depend on the underlying causes of the crisis, patient’s demographics, cardiovascular risk and comorbidities. For emergencies a maximum BP reduction of 20-25% within the first hour and then to 160/110-100 over next 2-6 h, is considered appropriate with a further gradual decrease over the next 24-48 h to reach normal BP levels. In the case of hypertensive urgencies, a gradual lowering of BP over 24-48 h with an oral medication is the best approach and an aggressive BP lowering should be avoided. Subsequent management with particular attention on chronic BP values control is important as the right treatment of the acute phase. [ABSTRACT FROM AUTHOR]