In the first 24 hours after an insult, attention to detail, such as the position of the patient's bed, is critical to the outcome of ischemic stroke.

Most cases of stroke are associated with difficulty in blood supply in a specific area of ??the brain.

In this case, the sitting position can harm the patient, because with it the supply of blood to the ischemic site decreases.

"Thus, it is advisable to keep patients in a lying position; the head should be as low as possible, "writes a neurologist at the Loyola University Medical Center in MedLink Neurology, Dr. Murray Flaster,.

But with stroke can also increase intracranial pressure, which leads to brain damage. Seated position contributes to improvement of outflow and decrease in intracranial pressure - but due to deterioration of blood supply.

"We do not have enough data to make a decision in such complicated cases," write Dr. Fluster and his colleagues.

In the future, the situation only becomes more complicated, some patients develop orthopnea (dyspnea associated with being in a lying position). In this case, experts recommend keeping the top of the bed as low as the patient can tolerate.

"Finally, frequent changes in the position of the body, regardless of the level of the head, can help the patient for a long time to lie down, minimize the risk of pressure sores," say neurologists from Loyola.

The position of the bed is one of the most difficult issues that Dr. Flaster touches in his article, which summarizes all the latest advances in the care of patients with ischemic stroke.

"The period immediately after an acute ischemic stroke is the time of the highest risk. The increased attention to detail in the care of patients during this period can prevent further neurological disorders and minimize the risk of normal complications, optimizing the chances of functional recovery, "- writes the doctor..

The authors discuss other factors that affect the outcome of ischemic stroke. For example, there is evidence of a link between hyperglycemia (elevated sugar levels) and poor outcomes of a stroke. The authors recommend strictly controlling sugar, often doing tests and conducting aggressive insulin treatment, regardless of the history of diabetes.

When the patient's body temperature increases with a stroke for every degree, the risk of death or severe disability increases more than 2-fold. Therapeutic hypothermia has shown efficacy in the event of cardiac arrest, and today the US is conducting clinical trials of hypothermia in ischemic stroke.

While these studies have not been completed, scientists recommend maintaining the body temperature of patients in the range of 95.9-99.5 F.

The authors discuss other issues, including control of blood pressure, circulating blood volume (BCC), treatment of possible complications (pneumonia, sepsis), etc..

Studies show that treating patients with ischemic stroke in specialized departments (Neuro ICU) can reduce mortality, increase the likelihood of rapid discharge, improving functional status and quality of life.

medbe. en.

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