Abstract Details

Title Head-of-Bed Positioning in Large Artery Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-005

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.

Authors/Disclosures
Howe Keat Chin, MBBS PRESENTER	Dr. Chin has nothing to disclose.
Shivangi Pandya, MBBS (National University Hospital Singapore)	Dr. Pandya has nothing to disclose.
Mingxue Jing, MBBS (National University Hospital, Singapore)	Dr. Jing has nothing to disclose.
Benjamin Yong Qiang Tan	Benjamin Yong Qiang Tan has nothing to disclose.
Leonard L. Yeo, MBBS (NUHS)	The institution of Dr. Yeo has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Astrazeneca. The institution of Dr. Yeo has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for stryker. Dr. Yeo has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for NUHS. Dr. Yeo has received stock or an ownership interest from cereflo. The institution of Dr. Yeo has received research support from NMRC.
Bernard P. Chan, MD (National University Hospital)	The institution of Dr. Chan has received research support from National University Hospital, Singapore.
Vijay Sharma	No disclosure on file

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