For Stroke Patients, Hospital Bed Position is a Delicate Balancing Act

Dean Reinke
Deans’ Stroke Musing

Wednesday, November 5, 2014

Well, what is your doctors stroke protocol on this? Has it changed from this earlier research? Does your doctor even know about any of this? It is only 3 years old.

• Optical Bedside Monitoring of Cerebral Blood Flow in Acute Ischemic Stroke Patients During Head-of-Bed Manipulation April, 2014
• HOBOE (Head-of-Bed Optimization of Elevation) Study: association of higher angle with reduced cerebral blood flow velocity in acute ischemic stroke May, 2012
• The influence of positioning upon cerebral oxygenation after acute stroke: a pilot study Nov, 2011
• The latest here: For stroke patients, hospital bed position is a delicate balancing act

Bed position is an example of how attention to detail improves outcomes MAYWOOD, Ill. (Oct. 30, 2014) – During the first 24 hours after a stroke, attention to detail - such as hospital bed positioning - is critical to patient outcomes. Most strokes are caused by blood clots that block blood flow to the brain. Sitting upright can harm the patient because it decreases blood flow and oxygen to the brain just when the brain needs more blood.

Thus it’s reasonable to keep patients lying flat or as nearly flat as possible, according to a report in the journal MedLink Neurology by Loyola University Medical Center neurologist  Murray Flaster, MD, PhD, and colleagues.

But strokes also can increase intracranial pressure (brain swelling) that can damage the brain. Sitting upright helps improve blood drainage and reduces intracranial pressure, but at a cost of reduced blood flow to the brain. “There are few data to guide decision making in this difficult situation,” Flaster and his colleagues write. Further complicating stroke care, some patients have orthopnea (difficulty breathing while lying flat). In such patients, the head of the bed should be kept at the lowest elevation the patient can tolerate.

Finally, frequent changes in body position, regardless of head position, may help patients tolerate lying flat, while also minimizing the risk of bed sores, the Loyola neurologists write.
Bed position is among the complex issues that Flaster and his colleagues address in their article, which summarizes the latest research on caring for ischemic stroke patients. (Most strokes are ischemic, meaning they are caused by blood clots.) “The period immediately following an acute ischemic stroke is a time of significant risk,” the Loyola neurologists write. “Meticulous attention to the care of the stroke patient during this time can prevent further neurologic injury and minimize common complications, optimizing the chance of functional recovery."

See the original article:

For Stroke Patients,
Hospital Bed Position is a Delicate Balancing Act

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Deans' Stroke Musing