Simple measures to control fever, elevated blood sugar and swallowing dysfunction improve recovery of stroke patients, reports The Lancet. Stroke is a leading cause of death and disability worldwide; lion's share of the focus continues to be on the acute management of the condition, revascularization interventions etc. We often overlook another equally important aspect - follow up care.
Stroke after care, which includes simple protocols to prevent fever, hyperglycemia, and aspiration pneumonia, can lead to profound differences in patients who survive stroke. Patients who receive after care are less likely to die or be dependent and have improved physical function at 90 days compared to patients given standard care. The study making these conclusions was published Online First by The Lancet, and was carried out by Professor Sandy Middleton, and his team.
AdvertisementIt is true that organised stroke unit care has significantly reduced deaths and disability from stroke. Attention continues to be limited to the management of the patient in the first 72 hours flowing stroke. In spite of the attached importance of hyperglycaemia, swallowing management and fever to long-term patient recovery, these entities are not managed well.
The recent study was performed at 19 acute stroke units (ASUs) in New South Wales, Australia. The fever, hyperglycaemia, and swallowing nursing care protocol was weighed against the current stroke management guidelines. Fever was managed by monitoring the patients' temperature every 4 hours and where required, paracetamol was used to lower temperature. Blood sugar shoot-ups (termed hyperglycemia) were kept in check by frequent blood glucose monitoring and timely infusions of insulin or saline depending on blood sugar levels and whether diabetes was present or absent. Swallowing difficulties were also taken care of so as to prevent a condition called aspiration pneumonia (a major cause of death in stroke patients). Aspiration pneumonia is a fatal inflammation of the lungs and airways following inhalation of foreign material.
Patients who received the fever, hyperglycaemia, and swallowing nursing care protocol were found to be 16 per cent more likely to be alive and independent after three months compared to those who received the 'standard care'. It is thus clear that nursing care makes a significant difference for stroke patients after discharge.
Source: "Implementation of evidence-based treatment protocols to manage fever, hyperglycemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial." The Lancet, Early Online Publication, 12 October 2011.