[Current concepts of intensive care of space-occupying middle cerebral artery infarct]

The aim of this paper is to review new developments in the intensive care of patients with space-occupying middle cerebral artery infarctions. Elevated blood pressure should not be treated; however, there is no scientific basis to induce arterial hypertension in these patients. It is not recommended generally to nurse the patients in a position with the head elevated. If therapy is targeted for an optimum cerebral perfusion pressure, the patients should be nursed in a flat position. Decompressive surgery is associated with a marked reduction in an otherwise high mortality. The functional outcome after surgery is similar to the outcome of the survivors after conventional treatment alone. Treatment options for an acutely raised intracranial pressure are mannitol or hypertonic saline solutions, although the long-term effects have not been ascertained yet. There is not enough evidence supporting a prophylactic standard therapy with hypertonic solutions. Patients who require artificial ventilation can be safely ventilated using PEEP or an inverse inspiration/expiration ratio, if the blood pressure is monitored and a possible drop of the arterial blood pressure is treated. Corticoids and hemodilution are obsolete therapies in these patients.