Systematic ReviewResearchWorkflow

Intensive blood-pressure lowering after stroke reperfusion probably increased mortality without meaningful functional benefit

The Cochrane database of systematic reviews (PubMed)Jul 14, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A Cochrane review of nine randomized trials involving 4,381 adults found that intensive systolic targets below 160 mmHg after ischemic-stroke reperfusion produced no clinically meaningful functional or hemorrhage benefit and probably increased all-cause mortality.

What NurseJet pulled from the source

This Cochrane review compared intensive systolic blood-pressure targets below 160 mmHg with conventional targets, generally below 180 mmHg, after thrombolysis or endovascular thrombectomy for ischemic stroke. Nine randomized trials included 4,381 participants. Intensive management produced little to no clinically meaningful difference in functional outcomes and did not change the risk of any intracranial hemorrhage (RR 0.99, 95% CI 0.87 to 1.14). It probably increased all-cause mortality (RR 1.19, 95% CI 1.08 to 1.32) and probably reduced the proportion of participants with favorable neurologic status, although the estimate included the possibility of little difference. The review does not support assuming that a lower post-reperfusion target is safer or more effective for every patient.

Why this matters for nurses

Stroke and critical-care nurses repeatedly measure blood pressure, assess neurologic status, administer ordered antihypertensives, and escalate deviations after reperfusion. This review matters because it challenges the intuitive assumption that pushing systolic pressure lower than conventional targets necessarily improves recovery.

Bedside takeaway

Be aware that intensive systolic targets below 160 mmHg after stroke reperfusion probably increased mortality without meaningful functional or hemorrhage benefit.

How This Applies in Practice

Use this when: Caring for an adult after thrombolysis or endovascular thrombectomy under an approved post-reperfusion blood-pressure pathway.

On your shift

Confirm the ordered systolic target and treatment threshold instead of assuming that the most intensive target is preferred.
Trend blood pressure alongside neurologic assessments and promptly communicate out-of-range values or deterioration through the stroke escalation pathway.

Keep in mind: The review compared several intensive targets and does not define one target for every patient. Follow facility protocol and patient-specific provider orders.

Explain this for my unit

Key takeaways

The review included nine randomized trials and 4,381 adults after thrombolysis or endovascular thrombectomy.
Intensive systolic targets below 160 mmHg did not produce a clinically meaningful functional benefit.
Any intracranial hemorrhage was similar with intensive and conventional management.
Intensive management probably increased all-cause mortality, with a pooled risk ratio of 1.19.

Practice implications

Use the prescribed post-reperfusion target and the facility's stroke protocol rather than treating a lower systolic pressure as automatically better. Pair blood-pressure surveillance with neurologic reassessment and promptly communicate out-of-range values or clinical deterioration to the stroke team.

Limitations & cautions

The intensive targets varied across trials, including thresholds below 120, 140, and 160 mmHg; seven studies involved thrombectomy and two involved thrombolysis. Studies were mainly from upper-middle- and high-income countries, and certainty ranged from high to very low across outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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The Cochrane database of systematic reviews (PubMed)

The Cochrane database of systematic reviews (PubMed). Blood pressure management in reperfused ischemic stroke.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42445947/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Hospital Pediatrics (PubMed)Jul 14, 2026Systematic ReviewPractice applicable

A systematic review of 23 pediatric inpatient studies found that most alarm-reduction projects lowered monitor-alarm frequency and every study measuring nonactionable alarms reported a decrease, but study heterogeneity prevented comparison of individual strategies and safety balancing measures were inconsistent.

Peds ICUAI summaryReview source

Systematic ReviewResearchQuality ImprovementWorkflowPractice applicableAI summary · original source linked below

This systematic review examined interventions intended to reduce pulse-oximeter and cardiorespiratory-monitor alarms in pediatric inpatient care. The 23 included studies comprised 12 NICU studies, two PICU studies, eight medical-surgical studies, and one spanning PICU and medical-surgical care; 16 were quality-improvement studies, five were nonrandomized, and two were randomized trials. Common approaches included staff education, universal or patient-specific parameter changes, longer alarm delays, and standardized communication about monitoring plans. Most studies reported fewer alarms, and every study that measured nonactionable alarms reported a decrease. However, heterogeneity prevented comparison of individual interventions, balancing measures were inconsistently reported, and the review found no standardized method for synthesizing quality-improvement studies.

Key takeaways

The review included 23 studies across neonatal, pediatric intensive-care, and pediatric medical-surgical settings.
Sixteen studies were quality-improvement projects, five were nonrandomized, and only two were randomized trials.
Most studies reported lower alarm frequency, and all studies measuring nonactionable alarms reported decreases.
The review could not compare individual interventions because of heterogeneity, and safety balancing measures were reported inconsistently.

Why this matters on shift

Pediatric nurses are exposed to repeated monitor alarms and are central to monitoring-plan communication and response. This review matters because it identifies recurring alarm-reduction approaches while warning that lower alarm counts alone do not establish that a change is safer.

Bedside takeaway

Worth knowing that pediatric alarm-reduction projects usually lowered alarm counts, but heterogeneous methods and inconsistent safety balancing measures prevent naming one best approach.

Nursing implications

Pediatric units can use the review to structure approved alarm-reduction work around clear monitoring plans, staff education, nonactionable-alarm measurement, and balancing outcomes. Alarm limits or delays should not be changed outside approved orders and unit protocols, and the review did not identify one superior approach.

Limitations & cautions

The evidence was dominated by heterogeneous quality-improvement and nonrandomized studies, with only two randomized trials. Intervention effects could not be compared, balancing measures were inconsistent, no pooled effect estimate was available, and methods for systematically reviewing quality-improvement studies are not standardized.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Hospital Pediatrics (PubMed). Interventions to Reduce Monitor Alarms Across Pediatric Inpatient Settings: A Systematic Review.

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The Journal of International Medical Research (PubMed)Jul 10, 2026Research ArticlePractice applicable

In a single-center randomized trial of 405 postoperative adults aged 60 or older in an orthopedic ICU, flexible daytime family visitation reduced delirium from 44.4% to 29.5% and sedative use from 44.9% to 32.0%, without a detected increase in hospital-acquired infection or length of stay.

ICU GeriatricsAI summaryReview source

Research ArticleResearchPolicyQuality ImprovementPractice applicableAI summary · original source linked below

This parallel-group randomized trial enrolled 405 adults aged 60 or older who entered one orthopedic ICU within 24 hours after surgery. Participants received either flexible daytime family visitation or routine restricted visitation, and delirium was assessed daily with the CAM-ICU and Intensive Care Delirium Screening Checklist. Delirium occurred in 29.5% with flexible visitation and 44.4% with restricted visitation; sedative use was 32.0% versus 44.9%. Hospital-acquired infection was similar (3.5% versus 3.9%), and median length of stay was 16 days in both groups. Hospitalization costs were lower with flexible visitation. A cervical-spine subgroup appeared to benefit most, but that surgical-type analysis was exploratory.

Key takeaways

The trial randomized 405 postoperative adults aged 60 or older in a single orthopedic ICU.
Flexible daytime visitation reduced measured delirium from 44.4% to 29.5%.
Sedative use was lower, while hospital-acquired infection and median length of stay did not differ significantly.
The apparent larger benefit after cervical-spine surgery came from an exploratory subgroup analysis.

Why this matters on shift

ICU nurses perform delirium surveillance, coordinate family presence, and work within visitation and infection-control policies. This trial matters because it evaluated a modifiable care-environment policy and included delirium, sedative exposure, infection, length of stay, and cost rather than a single outcome.

Bedside takeaway

Be aware that flexible daytime family visitation reduced delirium and sedative use in one orthopedic ICU without a detected rise in infection or length of stay.

Nursing implications

The findings support local review of structured daytime family access as one component of postoperative delirium prevention for older orthopedic ICU patients. Individual nurses should not change visitation restrictions independently; implementation requires an approved policy, consistent delirium assessment, and monitoring of balancing outcomes.

Limitations & cautions

This was a single-center orthopedic ICU study limited to postoperative adults aged 60 or older. Visitation could not be blinded, the results may not transfer to other ICU populations or visitation models, cost findings are setting-specific, and the surgical-subgroup result was exploratory.
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Citations · exact source links

The Journal of International Medical Research (PubMed). Flexible family visitation and postoperative delirium in an orthopedic intensive care unit: A randomized trial examining surgical-type heterogeneity and cost outcomes.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Heart (PubMed)Nov 23, 2025Research ArticlePractice applicable

Across 12 hospitals in five Asian countries, an ESC 0/1-hour high-sensitivity troponin T pathway produced noninferior 30-day major adverse cardiac events compared with usual care and increased emergency-department discharge from 35% to 60%.

Emergency TelemetryAI summaryReview source

Research ArticleResearchWorkflowPractice applicableAI summary · original source linked below

This prospective stepped-wedge cluster-randomized trial enrolled 3,869 patients with suspected non-ST-elevation acute coronary syndrome at 12 hospitals in five Asian countries. Usual care used troponin testing without standardized timing; the intervention used high-sensitivity cardiac troponin T at baseline and 1 hour according to the ESC pathway. Thirty-day major adverse cardiac events occurred in 1.7% with usual care and 1.4% with the 0/1-hour pathway, meeting the prespecified 1.5% noninferiority margin. Emergency-department discharge increased from 35% to 60%. Among 941 patients classified as low risk, three had a 30-day event: one cardiovascular death and two unplanned revascularizations, with no nonfatal myocardial infarctions. The results support this specific assay-based protocol in the settings studied, not unsupervised use of an isolated troponin value.

Key takeaways

The trial included 3,869 patients with suspected non-ST-elevation acute coronary syndrome across 12 hospitals and five countries.
The intervention standardized high-sensitivity troponin T testing at baseline and 1 hour.
Thirty-day major adverse cardiac events were 1.4% with the pathway and 1.7% with usual care, meeting the trial's noninferiority criterion.
Emergency-department discharge increased from 35% to 60%, although three 30-day events occurred among 941 patients classified as low risk.

Why this matters on shift

Emergency nurses coordinate time-sensitive chest-pain assessment, specimen collection, reassessment, and disposition communication. This study matters because it tested a standardized rapid pathway across diverse hospitals and measured both safety and patient flow rather than speed alone.

Bedside takeaway

Be aware that a standardized ESC 0/1-hour troponin T pathway increased ED discharge from 35% to 60% while meeting noninferiority for 30-day cardiac events across 12 Asian hospitals.

Nursing implications

ED teams can use the findings when evaluating a locally approved 0/1-hour high-sensitivity troponin T pathway with clear eligibility, timing, interpretation, and escalation rules. The study does not support substituting a single result for the full protocol or applying its cutoffs to a different assay without validation.

Limitations & cautions

This was a stepped-wedge cluster trial rather than individual randomization and used high-sensitivity troponin T in Asian emergency departments. Transfer to other populations, assays, cutoffs, and workflows requires local validation, and a small number of 30-day events still occurred among patients classified as low risk.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Heart (PubMed). Validation of the European Society of Cardiology 0/1-hour algorithm for chest pain triage in Asian emergency departments: a multinational stepped-wedge cluster-randomised trial.

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Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Pediatric monitor-alarm projects usually reduced alarm burden, but safety balancing measures were inconsistent

Flexible daytime family visitation lowered postoperative delirium from 44% to 30% in one orthopedic ICU

The ESC 0/1-hour chest-pain pathway raised ED discharge from 35% to 60% with noninferior 30-day cardiac events