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(Stroke. 2004;35:1019.)
© 2004 American Heart Association, Inc.

Controversies in Stroke

Intensive Monitoring Should Not Be the Routine

From the Stroke Unit, Department of Medicine, University Hospital of Trondheim, Norway.

Correspondence to Dr Bent Indredavik, Stroke Unit, Department of Medicine, University Hospital of Trondheim, N 7006 Trondheim, Norway. E-mail Bent.Indredavik@medisin.ntnu.no

Key Words: monitoring, physiologic • stroke management • stroke unit

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The main objective of acute stroke care should be to reduce death and disability, and the objective of monitoring should be the same. Treatment in stroke units (without intensive monitoring) is the only treatment option proven to reduce death in acute stroke patients, and also the only treatment that has shown beneficial long-term effects on survival and disability.¹ All acute stroke patients seem to benefit from stroke unit treatment.¹

Among the different stroke unit models, the (nonintensive) comprehensive model, which combines acute treatment and rehabilitation, has been most extensively tested in randomized trials and has achieved the most favorable results. The characteristic features of care provided by such units are: (1) a standardized protocol for acute evaluation, monitoring, and medical treatment; (2) a strategy for early mobilization; (3) a strong focus on rehabilitation with an average duration of at least 1 week; (4) a multidisciplinary team; and (5) integration of medical care, nursing, and rehabilitation.² According to our current knowledge, all these aspects are necessary for evidence-based stroke unit care.^1,2

During recent years the importance of one aspect, monitoring and control of physiological factors, has received increased attention. As some data from the randomized stroke unit trials indicate, control of physiological factors might be important for recovery.^2–4 Today most stroke units have a systematic approach to maintenance of physiological homeostasis during the first few days.^2–4 Hence, the question is not whether acute stroke patients should have monitoring or not, but rather how intensive (continuous or intermittent) and how extensive (how . . . [Full Text of this Article]

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