Effect of head positioning on intracranial blood flow velocities in acute ischemic stroke: A pilot study

Anne Alexandrov, Ashraf El-Mitwalli, Andrei Alexandrov

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Current nursing practice for the care of patients with ischemic stroke advocates routine elevation of the head of the bed (HOB) to 30°. Evidence supporting this practice is lacking, and it may reflect inappropriate generalization of findings from studies conducted primarily on traumatic brain injury patients with associated increased intracranial pressure to the ischemic stroke population. We used a repeated measures design to conduct a pilot study of the effect of three HOB positions on middle cerebral artery mean flow velocities (MCA-MFV) in patients with acute ischemic stroke. Transcranial Doppler (TCD) sonography was used to measure MCA-MFV. Eleven patients were enrolled in the study; the mean age of the sample was 60 years, and the mean National Institutes of Health Stroke Scale score was 8.7. On average, a 9.2% increase in MCA-MFV was measured when the HOB was lowered to 15° from the 30° elevation standard (p= .02); MCA-MFV increased on average by 3.9% when the HOB was again lowered from the 15° position to the 0° (flat) position (p=not significant). Mean arterial pressure, heart rate, and pulse pressure remained stable without significant change throughout the positioning intervention and measurement period. The overall increase in MCA-MFV achieved from lowering the HOB position from 30° to a flat position was 13.1% (p = .054). Our findings from this small sample suggest that patients with acute ischemic stroke may benefit from lower HOB positions, in particular flat positioning, to promote an increase in flow to ischemic brain tissue that may ultimately reduce brain infarct volume.

Original languageEnglish (US)
Pages (from-to)57-66
Number of pages10
JournalCritical Care Nursing Quarterly
Volume24
Issue number4
DOIs
StatePublished - Jan 1 2002
Externally publishedYes

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Blood Flow Velocity
Middle Cerebral Artery
Stroke
Head
Doppler Transcranial Ultrasonography
National Institutes of Health (U.S.)
Intracranial Pressure
Brain
Nursing Care
Arterial Pressure
Heart Rate
Blood Pressure
Population

All Science Journal Classification (ASJC) codes

  • Critical Care

Cite this

Effect of head positioning on intracranial blood flow velocities in acute ischemic stroke : A pilot study. / Alexandrov, Anne; El-Mitwalli, Ashraf; Alexandrov, Andrei.

In: Critical Care Nursing Quarterly, Vol. 24, No. 4, 01.01.2002, p. 57-66.

Research output: Contribution to journalArticle

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