A 72-year-old man is admitted to the neurocritical care unit after presenting with a sudden onset severe headache and right-sided weakness. A head CT reveals a large left putaminal intracerebral hemorrhage (ICH) with mild midline shift. He is currently intubated and on assist-control ventilation, with a continuous nicardipine infusion running via a central line to maintain a systolic blood pressure between 140–160 mmHg. His initial coagulation studies are within normal limits (INR 1.0, aPTT 28 seconds, platelets 250,000/mcL). Despite aggressive blood pressure management, a repeat CT scan 3 hours later shows a 30% increase in hematoma volume. The clinical team is discussing options, including the potential use of recombinant activated factor VII (rFVIIa) to halt further bleeding. Which of the following is the most appropriate consideration regarding the use of recombinant activated factor VII (rFVIIa) for this patient?

A 65-year-old man is admitted to the neurocritical care unit following a spontaneous intracerebral hemorrhage confirmed by CT scan. He remains intubated and on volume-control mechanical ventilation with a central venous catheter in place. His Glasgow Coma Scale is 8 (E2V1M5). He is agitated and frequently asynchronous with the ventilator, complicating reliable neurological examinations. His blood pressure is 130/80 mmHg on low-dose norepinephrine. Management goals include ensuring ventilator synchrony, hemodynamic stability, and the ability to perform serial neurological assessments. Which continuous sedation strategy is most appropriate for this patient?

A 72-year-old man is admitted to the critical care unit following a spontaneous intracerebral hemorrhage (ICH). He is intubated and on assist-control ventilation, with a continuous norepinephrine infusion running through a central venous catheter to maintain mean arterial pressure. His medical history includes atrial fibrillation, for which he was taking apixaban 5 mg twice daily. Upon arrival, his INR was 1.1 and anti-Xa level was elevated. He received 1000 mg of andexanet alfa as a bolus followed by a 4-hour infusion. His initial head CT showed a 35 mL right putaminal hemorrhage, and a repeat CT 6 hours later showed no significant hematoma expansion. His blood pressure is now stable, and his electrolytes are within normal limits. Given the patient’s clinical status and recent intervention, which of the following represents the most significant risk in the immediate post-reversal period?

A 72-year-old, 70-kg man with a spontaneous intracerebral hemorrhage is intubated and sedated in the neurocritical care unit. His serum sodium is 140 mEq/L, creatinine is 0.9 mg/dL, and he is on norepinephrine via a central line to maintain cerebral perfusion pressure. His Glasgow Coma Scale remains 7. During neurologic assessment, his right pupil acutely dilates to 5 mm and becomes sluggishly reactive, compared with 3 mm and briskly reactive one hour earlier, suggesting uncal herniation. No intracranial pressure monitor is in place. Which of the following pharmacologic interventions is most appropriate to achieve rapid intracranial pressure reduction?

A 72-year-old man with a spontaneous intracerebral hemorrhage (ICH) is intubated and sedated with a continuous propofol infusion at 30 mcg/kg/min to maintain a Richmond Agitation-Sedation Scale (RASS) score of –4. He has stable intracranial pressure (ICP) of 12 mmHg and cerebral perfusion pressure (CPP) of 75 mmHg. Neurological examinations have been limited by deep sedation, and no sedation interruption trial has been performed since admission. Given his stable neurological parameters, which of the following is the most appropriate next step in sedation management?

A 72-year-old man is in the neurocritical care unit following a large left putaminal intracerebral hemorrhage (ICH). He is intubated on assist-control ventilation and has a central venous catheter. His Glasgow Coma Scale (GCS) score is 7 (E1V2M4). During nursing rounds, it is noted that his pupils have become sluggishly reactive. There is concern for worsening perihematomal edema and elevated intracranial pressure (ICP). His systolic blood pressure is currently 145 mmHg on a nicardipine infusion. Given this new neurologic finding, which of the following interventions is most appropriate for the immediate management of suspected elevated ICP?

A 68-year-old man is being managed in the neurocritical care unit for a spontaneous intracerebral hemorrhage (ICH). On day 3, he is breathing spontaneously with a Glasgow Coma Scale score of 14 (E4V4M6). Continuous infusions have been weaned, and his blood pressure is stable (systolic 130–140 mm Hg) on oral agents. A follow-up head CT performed 48 hours after admission shows no hematoma expansion or new cerebral edema. He has peripheral IV access only and is tolerating clear liquids. Which finding is most critical for determining the appropriateness of transferring this patient from the ICU?

An 82-year-old woman is admitted to the neurocritical care unit with a spontaneous right temporal intracerebral hemorrhage (ICH). A follow-up CT scan 12 hours after admission shows significant perihematomal edema. She is intubated for airway protection with a Glasgow Coma Scale of 8 (E2 V1 M5) and has an intracranial pressure (ICP) bolt in place, with pressures fluctuating between 20 and 25 mm Hg. Her blood pressure is controlled with a continuous nicardipine infusion via a central line. Which of the following is inappropriate for reducing her cerebral edema?

A 62-year-old male is admitted to the critical care unit following a spontaneous intracerebral hemorrhage (ICH) involving the right putamen, confirmed by a non-contrast head CT. He is currently intubated and on assist–control ventilation, receiving a continuous propofol infusion for sedation, and has a central venous catheter in place. His neurological exam shows left-sided hemiparesis, and he is nonambulatory. Repeat head CT 6 hours after admission shows no significant expansion of the hematoma.

Given the patient’s presentation and balancing the hemorrhagic versus thrombotic risks, which of the following is the MOST appropriate initial venous thromboembolism (VTE) prophylaxis strategy?

A 65-year-old man is in the intensive care unit following a spontaneous intracerebral hemorrhage. He remains mechanically ventilated on pressure support, has a central venous catheter, and is receiving infusions of propofol (5 mcg/kg/min) and fentanyl (25 mcg/hr). On admission his blood pressure was 200/110 mmHg, and a systolic target of <140 mmHg was instituted. Forty-eight hours later his neurological status is stable, repeat head CT shows no hematoma expansion, and his BP is consistently 130/80 mmHg. What is the most appropriate management step now?