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Heads down: flat positioning improves blood flow velocity in acute ischemic stroke
Anne W Wojner-Alexander1, Zsolt Garami, Oleg Y Chernyshev
1Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA. Anne.W.Wojner@uth.tmc.edu
Neurology
|April 27, 2005
Summary
Lowering the head of the bed (HOB) for acute stroke patients significantly increases blood flow velocity in the middle cerebral artery. This simple position change may improve blood flow to ischemic brain tissue.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Devices
Background:
- Current practice of elevating the head of the bed (HOB) at 30 degrees for acute stroke patients lacks evidence.
- Intracranial pressure is not a proven concern necessitating this routine HOB elevation.
Purpose of the Study:
- To investigate the real-time effects of different HOB positions on residual blood flow velocity in acute stroke.
- To determine if lower HOB positions increase resistance to residual blood flow.
Main Methods:
- A repeated-measures quasi-experimental design was used.
- Transcranial Doppler measured middle cerebral artery (MCA) mean flow velocity (MFV) and pulsatility index (PI) in 20 acute ischemic stroke patients (<24 hours).
- HOB positions were tested at 30, 15, and 0 degrees.
Main Results:
- MCA MFV increased with lower HOB positions, with an average increase of 20% across all patients.
- No significant changes in mean arterial pressure, heart rate, or PI were observed, indicating no increased resistance.
- 15% of patients experienced immediate neurologic improvement after lowering the HOB.
Conclusions:
- Lowering the head of the bed position in acute ischemic stroke patients can enhance residual blood flow to affected brain areas.
- This finding suggests a potential benefit of modifying HOB positioning to improve outcomes in stroke patients.