Objective:

We evaluate whether 0-degree head-of-bed (HOB) positioning is associated with neurological stability, without increasing the risk of aspiration pneumonia in hyperacute large artery ischemic stroke (IS). 

Background:

Flat (0-degree) HOB positioning may increase blood flow across arterial occlusion in hyperacute large artery ischemic stroke (IS), with some clinical improvement. However, this position may increase the risk of aspiration pneumonia.

Design/Methods:

In this ongoing clinical trial, hyperacute IS patients due to large artery occlusion on CT angiography are randomized to stay in flat HOB or head-elevated (at least 30-degrees) position. Only patients eligible for intravenous thrombolysis and/or mechanical thrombectomy are recruited. Serial NIHSS scoring is performed at 15-minutes interval for 1-hour or until HOB is changed due to medical reasons. Neurological stability is assessed by significant neurological deterioration (NIHSS score increase of 4 or more) during monitoring period. Safety of 0-degree HOB is evaluated by evidence of aspiration or hospital-acquired pneumonia (HAP).

Results:

Of the 122 patients recruited so far, 64 were randomized to 0-degree HOB and both groups were well-matched. Median age was 58-years (range 38-76), 66% male with median NIHSS 13-points (range 7-23). Compared to only 4/64 (6.3%) patients in 0-degree HOB, 10/58 (17.2%) patients with elevated HOB developed significant neurological deterioration (p= 0.001). Fourteen (11.5%) patients developed HAP without any difference between the HOB positions (p=0.241). Flat-HOB was an independent predictor of neurological stability (HR 4.145, CI 2.4-11.6; p=0.004).

Conclusions:

Flat HOB in hyperacute large artery ischemic stroke is associated with neurological stability, without any significant increase in aspiration pneumonia.