Stroke Care Unit Treatment: Rationale, Features and Efficacy

We are witnessing important developments in the care of patients with acute ischemic stroke. Admission of patients to dedicated inpatient stroke units reduces mortality, dependency and the need for institutional care. The benefits of organised stroke care have been attributed to rehabilitation input mainly. In the pursuit of further development of optimal stroke care, attention has been attributed to physiological disturbances, including hypotension, hyperthermia, hypoxia, and glycemia that enhance secondary damage in the ischemic brain area and worsen outcome. Due to neurological impairment, acute ischemic stroke patients are highly susceptible for the development of complications, such as (chest) infections, dehydration, autonomic dysfunction and cardiac adverse events in the acute phase of stroke. These complications can easily lead to the development of physiological disturbances and consecutively enhance ischemic damage. This raises the possibility that rigorous attention to the prevention and early treatment of complications and physiological disturbances could considerably improve stroke outcome; more than any medication that is currently available or has been investigated in clinical trials. Monitoring in the acute phase of stroke of electrocardiogram, blood pressure, body temperature, oxygen saturation, and glucose concentration allows immediate intervention when disturbances occur. A critical appraisal of the interventions to treat these complications is warranted. For example, our antipyretic therapy should be further improved. In conclusion, this thesis gives evidence that monitoring of physiological variables in acute stroke patients may reduce mortality and poor outcome. Future research should aim for improving the basic intervention scheme to treat complications and physiological disturbances effectively and safely and to target the subgroup of stroke patients whom benefits the most of intensive stroke care.

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