Critical Care NurseBundled Care Interventions for the Management of Intracerebral Hemorrhage: A Review

Spontaneous intracerebral hemorrhage strikes 80,000 people in the United States annually with high disability and mortality. The 2024 AHA/ASA guidance now supports bundled care protocols, including timely BP control, anticoagulation reversal, and surgical intervention, modeled on the success seen in ischemic stroke care.

Key Clinical Considerations

• The critical care nurse is the frontline detector of neurologic decline, where minutes of recognition delay translate directly into expanded hematoma volume
• Blood pressure control is a core bundle element, requiring tight titration of IV antihypertensives and frequent reassessment, not just hourly checks
• Anticoagulation reversal must be initiated rapidly for patients on warfarin, DOACs, or antiplatelet agents; nurses anchor the workflow between pharmacy, lab, and provider
• Optimal timing and BP targets remain under study, so adherence to the institutional protocol matters more than improvisation at the bedside

Practice Applications

• Perform focused neuro checks at protocol-defined intervals and escalate any GCS or pupil change immediately
• Titrate antihypertensives to the ordered target without drift; document every BP and intervention
• Verify anticoagulation status on admission and have reversal agents prepared before the order arrives
• Anticipate surgical consult and prepare the patient for transport, imaging, or OR without delay