Flat-head positioning increases cerebral blood flow in anterior circulation acute ischemic stroke. A cluster randomized phase IIb trial.

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dc.contributor.authorOlavarria, Veronica
dc.contributor.authorLavados, Pablo
dc.contributor.authorMuñoz Venturelli, Paula
dc.contributor.authorGonzalez, Francisca
dc.contributor.authorGaete, Javier
dc.contributor.authorMartins, Sheila
dc.contributor.authorArima, Hisatomi
dc.contributor.authorAnderson, Craig
dc.contributor.authorBrunser, Alejandro
dc.date.accessioned2017-09-11T14:45:23Z
dc.date.available2017-09-11T14:45:23Z
dc.date.issued11/09/2017
dc.description.abstractBackground Whether lying-flat improves blood flow in patients with acute ischemic stroke is unknown. Our aim was to investigate if lying-flat "changes" cerebral blood flow velocities assessed by transcranial Doppler in acute ischemic stroke patients. Methods In a multicenter cluster clinical trial, we randomly assigned patients within 12 h from onset of a neurological deficit due to cerebral ischemia of the anterior circulation to lying-flat or upright head positioning. The primary outcome was a change of 8 cm/s or more in mean cerebral blood flow velocities on transcranial Doppler to the middle cerebral artery at 1 and 24 h post-randomization, adjusted for imbalance in baseline variables. Secondary outcomes included serious adverse events and physical functioning at 90 days. Results Ninety-four of 304 patients screened were recruited. The primary outcome occurred in 11 (26%) of 43 patients in the lying-flat group and in 6 (12%) of 51 in the upright group at 1 h (adjusted odds ratio, 3.81; 95% CI, 1.07 to 13.54), and in 23 (53%) and 18 (36%) patients in these respective groups at 24 h (adjusted odds ratio, 3.04; 95% CI, 1.08 to 8.53). There were no between-group differences in serious adverse events, including pneumonia, heart failure or mortality, nor in functional outcome at 3 months (adjusted common odds ratio, 1.38; 95% CI 0.64 to 3.00). Conclusion The lying-flat head position was associated with a significant increase in cerebral blood flow velocities at one and 24 h within the ipsilateral hemisphere of anterior circulation acute ischemic stroke, without serious safety concerns. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT01706094.
dc.format.extent12
dc.identifier.citationInt J Stroke. 2017 Jan 1:1747493017711943
dc.identifier.urihttp://hdl.handle.net/11447/1662
dc.identifier.urihttp://dx.doi.org/10.1177/1747493017711943
dc.language.isoen_US
dc.publisherSage Publications
dc.subjectIschemic stroke
dc.subjectblood flow velocities
dc.subjecthead position
dc.subjectmiddle cerebral artery
dc.subjectpilot trial
dc.subjecttranscranial Doppler
dc.titleFlat-head positioning increases cerebral blood flow in anterior circulation acute ischemic stroke. A cluster randomized phase IIb trial.
dc.typeArtículo

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