From the Guidelines
Vital sign management in stroke patients requires careful monitoring and targeted interventions, with a focus on maintaining blood pressure, temperature, blood glucose, and oxygen saturation within specific ranges to minimize morbidity and mortality, as recommended by the most recent guidelines 1.
Key Recommendations
- Blood pressure should be monitored every 15 minutes for the first 2 hours, then every 30 minutes for 6 hours, and hourly thereafter for at least 24 hours.
- For ischemic stroke patients not receiving thrombolysis, permissive hypertension is generally allowed up to 220/120 mmHg.
- If thrombolysis is planned, blood pressure should be maintained below 185/110 mmHg before treatment and below 180/105 mmHg for 24 hours after, using medications like labetalol or nicardipine.
- For hemorrhagic stroke, more aggressive blood pressure control is recommended, targeting systolic pressure below 140-160 mmHg.
- Temperature should be maintained below 37.5°C, treating fever with acetaminophen and cooling measures.
- Blood glucose should be kept between 140-180 mg/dL using insulin protocols if needed, avoiding hypoglycemia.
- Oxygen saturation should be maintained above 94%, with supplemental oxygen provided only if saturation falls below this threshold, as recommended by the British Thoracic Society guideline 1.
- Heart rate and rhythm require continuous monitoring, as atrial fibrillation may be detected post-stroke.
Rationale
These parameters are carefully managed because hypertension can worsen bleeding in hemorrhagic stroke or cause hemorrhagic transformation in ischemic stroke, while hypotension may compromise cerebral perfusion in the vulnerable penumbra surrounding the infarct. The guidelines from the World Stroke Organization 1 and the American Heart Association 1 provide a framework for the management of vital signs in stroke patients, with a focus on minimizing morbidity and mortality.
Additional Considerations
- The European Stroke Organisation recommendations 1 emphasize the importance of continuous monitoring of physiological parameters, including oxygen saturation, arterial blood pressure, heart rhythm, and body temperature.
- The American Heart Association guidelines 1 provide detailed recommendations for the management of vital signs, including blood pressure, temperature, and oxygen saturation, as well as the use of antithrombotic agents and other medications.
From the Research
Vital Signs in Stroke
- The provided studies do not directly address the guidelines for managing vital signs in a patient with a stroke.
- However, some studies discuss the management and treatment of stroke patients, including the use of antiplatelet therapy and thrombolysis 2, 3, 4, 5.
- One study mentions the importance of nursing care in the first 24 hours after a stroke, which may include monitoring vital signs, but does not provide specific guidelines 6.
- The American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) provides recommendations for the treatment and prevention of stroke, including the use of antithrombotic and thrombolytic therapy, but does not specifically address vital sign management 3.
- There is no direct evidence in the provided studies to support specific guidelines for managing vital signs in stroke patients.