Management of Acute Ischaemic Stroke in Vietnam

Acute stroke is commonly followed by dehydration, partly because the patient may have been unwell for some time before being taken to hospital and partly because once in hospital hydration may not be the first thing that gets dealt with. There may also be dysphagia and cannot swallow or they have reduced thirst sensation or reduced conscious levels. A paper by Bhalla et al. [1] showed quite a strong association between higher plasma osmolality (>296 mmol/l) measured in the week after stroke and 3 month mortality with an odds ratio of death of 2.4 (95% CI 1–5.9). Similar data from an Israeli patient registry [2] showed significant associations between hydration and modified Rankin scores and mortality after stroke at one year accounting for stroke severity. Lin et al. [3] reported an intervention study where patients were actively hydrated and showed that the percentage of patients with an mRS score of 2 or lower was significantly higher in the hydration group than that in the control group. Further evidence for the importance of maintaining hydration comes from the Sentinel Stroke National Audit Programme from the UK. With a database of over 32,000 patients, Bray et al. [4] showed that giving antiplatelet treatment and adequate fluid and nutrition for the first 2 h was associated with a 45% (95% CI 0.49–0.61) reduction in 3-month mortality compared to those patients who did not have those care processes documented or given. While all of these studies had methodological flaws it does appear that allowing a patient to become dehydrated is a risk factor for poorer outcomes.