Head Positioning for Intracranial Pressure Due to Brain Bleeds
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Milton S. Hershey Medical Center
Disqualifiers: Pulmonary hypertension, Cirrhosis, Clinically unstable, others
No Placebo Group
Approved in 1 Jurisdiction
Trial Summary
What is the purpose of this trial?The purpose of this study is to evaluate how pressure inside the skull responds to position changes in patients with brain bleeds.
Do I need to stop my current medications for this trial?
The trial protocol does not specify whether you need to stop taking your current medications.
What data supports the idea that Head Positioning for Intracranial Pressure Due to Brain Bleeds is an effective treatment?
The available research shows that elevating the head of the bed is a common practice for managing intracranial pressure in patients with brain injuries. For example, one study highlights that this position is standard for patients with severe traumatic brain injury, as it may help reduce pressure in the brain by improving blood flow and drainage. Another study indicates that while head elevation is standard, its effects on brain oxygen levels and circulation are still being explored. Overall, the research suggests that head positioning is widely used and believed to help manage brain pressure, although more data is needed to fully understand its benefits.
12345What safety data exists for head positioning in managing intracranial pressure?
The safety data for head positioning, including head-of-bed elevation, in managing intracranial pressure is mixed. Studies indicate that elevating the head of the bed can reduce intracranial pressure, which is beneficial for patients with cerebral edema or at risk of intracranial hypertension. However, there are concerns that it may also decrease cerebral perfusion pressure, potentially leading to cerebral ischemia. The optimal head positioning should be individualized, taking into account both intracranial pressure and cerebral perfusion pressure measurements. Further research is needed to refine these practices and ensure patient safety.
24678Is head positioning a promising treatment for managing intracranial pressure due to brain bleeds?
Yes, head positioning is a promising treatment for managing intracranial pressure from brain bleeds. Elevating the head of the bed can help reduce pressure in the brain by improving blood flow and oxygenation. This method is commonly used in patients with brain injuries to help manage pressure and improve recovery.
12345Eligibility Criteria
This trial is for adults over 18 with a confirmed subarachnoid hemorrhage who have devices to monitor skull pressure and arterial blood pressure. They must be able to consent or have someone who can. Excluded are those prone while intubated, with severe heart failure, pulmonary hypertension, clinical instability, multiple IV meds for blood pressure, active resuscitation, or serious liver issues.Inclusion Criteria
You have had bleeding in the space around your brain, confirmed by specific imaging tests.
I am 18 years old or older.
You have a device that measures pressure inside your head.
+2 more
Exclusion Criteria
I am on a breathing machine and can be laid face down.
My heart's pumping ability is very low.
I have been diagnosed with high blood pressure in the lungs.
+2 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
Treatment
Participants undergo positional changes to evaluate intracranial pressure response
10 days
Daily monitoring during hospitalization
Follow-up
Participants are monitored for safety and effectiveness after treatment
2 weeks
Participant Groups
The study tests how different body positions affect intracranial pressure in patients with brain bleeds. Positions include lying flat (supine), semi-reclined sitting up slightly (semi-recumbent), and semi-reclined with legs bent.
1Treatment groups
Experimental Treatment
Group I: Positional ChangesExperimental Treatment3 Interventions
The patient will begin in a supine position with the head-of-bed (HOB) at zero (0) degrees. The patient will remain in this position for five (5) minutes while pressure data is collected every fifteen (15) seconds. Next, the HOB will be adjusted to thirty (30) degrees. The patient will remain in this position for five (5) minutes while pressure data is collected every fifteen (15) seconds. Lastly, the HOB will remain at thirty (30) degrees and the foot-of-bed (FOB) will be adjusted to place the patient's leg in a dependent position. The patient will remain in this position for five (5) minutes while pressure data is collected every fifteen (15) seconds.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Penn State Milton S. Hershey Medical CenterHershey, PA
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Who Is Running the Clinical Trial?
Milton S. Hershey Medical CenterLead Sponsor
References
Heads down: flat positioning improves blood flow velocity in acute ischemic stroke. [2016]Acute stroke patients are routinely positioned with the head of the bed (HOB) elevated at 30 degrees despite lack of evidence for increased intracranial pressure.
The Impact of Head-of-Bed Positioning and Transducer Location on Cerebral Perfusion Pressure Measurement. [2019]Head-of-bed (HOB) elevation is the standard of care for patients with intracranial pressure monitoring at risk for intracranial hypertension. Measurement of cerebral perfusion pressure (CPP) based on HOB elevation and arterial transducer position has not been adequately studied.
Head of bed elevation in pediatric patients with severe traumatic brain injury. [2022]Head of bed (HOB) elevation to 30° after severe traumatic brain injury (TBI) has become standard positioning across all age groups. This maneuver is thought to minimize the risk of elevated ICP in the hopes of decreasing cerebral blood and fluid volume and increasing cerebral venous outflow with improvement in jugular venous drainage. However, HOB elevation is based on adult population data due to a current paucity of pediatric TBI studies regarding HOB management. In this prospective study of pediatric patients with severe TBI, the authors investigated the role of different head positions on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral venous outflow through the internal jugular veins (IJVs) on postinjury days 2 and 3 because these time periods are considered the peak risk for intracranial hypertension.
Effect of standardized orders and provider education on head-of-bed positioning in mechanically ventilated patients. [2019]Semirecumbent head-of-bed positioning in mechanically ventilated patients decreases the risk of developing ventilator-associated pneumonia (VAP). The purpose of this study was to determine whether the addition of a standardized order followed by the initiation of a provider education program would increase the frequency with which our patients were maintained in the semirecumbent position.
Impact of Head-of-Bed Posture on Brain Oxygenation in Patients with Acute Brain Injury: A Prospective Cohort Study. [2022]Therapeutic head positioning plays a role in the management of patients with acute brain injury. Although intracranial pressure (ICP) is typically lower in an upright posture than in a flat position, limited data exist concerning the effect of upright positioning on brain oxygenation and circulation. We sought to determine the impact of supine (0°) and semirecumbent (15° and 30°) postures on ICP, brain oxygenation, and brain circulation.
The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation: prospective randomized multivariable analysis. [2021]Adopting the 45° semirecumbent position in mechanically ventilated critically ill patients is recommended, as it has been shown to reduce the incidence of ventilator-associated pneumonia. Although the benefits to the respiratory system are clear, it is not known whether elevating the head of the bed results in hemodynamic instability. We examined the effect of head of bed elevation (HBE) on hemodynamic status and investigated the factors that influence mean arterial pressure (MAP) and central venous oxygen saturation (ScvO2) when patients were positioned at 0°, 30°, and 45°.
Positioning and intracranial hypertension: implications of the new critical pathway for nursing practice. [2016]Evidence based practice in nursing requires careful scrutiny of research studies to determine if there is support to continue existing protocols or if a change in clinical practice is warranted. Current nursing practice in critical care includes the routine elevation of the head of the bed (HOB) to 30 degrees or 45 degrees for patients with cerebral edema. Intracranial hypertension is a common complication of cerebral edema. New guidelines for medical management of intracranial hypertension have been developed and presented in a critical pathway. Positioning of patients with intracranial hypertension must be re-evaluated in light of the changing goals of medical management outlined in the critical pathway. The author of this article will critically appraise the research examining the impact of elevating the HOB on patients with intracranial hypertension within the context of the critical pathway parameters. Recommendations for positioning, in keeping with the new critical pathway for intracranial hypertension, will be suggested. Future research directions will be identified.
Management of intracranial hemodynamics in the adult: a research analysis of head positioning and recommendations for clinical practice and future research. [2019]Head elevation is a conventional nursing intervention used to control raised intracranial pressure and avoid complications in patients with neurotrauma or other conditions requiring management of intracranial hemodynamics. This therapy, however, provides a particular dilemma for health care providers. While elevating the head of the bed does decrease intracranial pressure, it may put some patients at risk for intracranial hypertension and cerebral ischemia due to decreases in cerebral perfusion pressure. This article analyzes research on head positioning that provides individual outcome measurements versus group means in adult patients with various conditions. The risk/benefit method of analysis used in this review revealed that in addition to only monitoring and controlling for ICP, we must also monitor and control CPP with a greater emphasis on this particular measurement. This analysis also revealed that optimal head positioning to manage intracranial hemodynamics should be decided upon on an individual basis using both ICP and CPP measurements.