But what do our doctors have to say about doing this for stroke? 6 posts on HOBOE (Head-of-Bed Optimization of Elevation) for your doctor to injest.
http://europepmc.org/abstract/med/292834341 ,
Abstract
Traumatic brain injury (TBI) is a major public health problem and a
fundamental cause of morbidity and mortality worldwide. The burden of
TBI disproportionately affects low- and middle-income countries.
Intracranial hypertension is the most frequent cause of death and
disability in brain-injured people. Special interventions in the
intensive care unit are required to minimise factors contributing to
secondary brain injury after trauma. Therapeutic positioning of the head
(different degrees of head-of-bed elevation (HBE)) has been proposed as
a low cost and simple way of preventing secondary brain injury in these
people. The aim of this review is to evaluate the evidence related to
the clinical effects of different backrest positions of the head on
important clinical outcomes or, if unavailable, relevant surrogate
outcomes.To assess the clinical and physiological effects of HBE during
intensive care management in people with severe TBI.We searched the
following electronic databases from their inception up to March 2017:
Cochrane Injuries' Specialised Register, CENTRAL, MEDLINE, Embase, three
other databases and two clinical trials registers. The Cochrane
Injuries' Information Specialist ran the searches.We selected all
randomised controlled trials (RCTs) involving people with TBI who
underwent different HBE or backrest positions. Studies may have had a
parallel or cross-over design. We included adults and children over two
years of age with severe TBI (Glasgow Coma Scale (GCS) less than 9). We
excluded studies performed in children of less than two years of age
because of their unfused skulls. We included any therapeutic HBE
including supine (flat) or different degrees of head elevation with or
without knee gatch or reverse Trendelenburg applied during the acute
management of the TBI.Two review authors independently checked all
titles and abstracts, excluding references that clearly didn't meet all
selection criteria, and extracted data from selected studies on to a
data extraction form specifically designed for this review. There were
no cases of multiple reporting. Each review author independently
evaluated risk of bias through assessing sequence generation, allocation
concealment, blinding, incomplete outcome data, selective outcome
reporting, and other sources of bias.We included three small studies
with a cross-over design, involving a total of 20 participants (11
adults and 9 children), in this review. Our primary outcome was
mortality, and there was one death by the time of follow-up 28 days
after hospital admission. The trials did not measure the clinical
secondary outcomes of quality of life, GCS, and disability. The included
studies provided information only for the secondary outcomes
intracranial pressure (ICP), cerebral perfusion pressure (CPP), and
adverse effects.We were unable to pool the results as the data were
either presented in different formats or no numerical data were
provided. We included narrative interpretations of the available
data.The overall risk of bias of the studies was unclear due to poor
reporting of the methods. There was marked inconsistency across studies
for the outcome of ICP and small sample sizes or wide confidence
intervals for all outcomes. We therefore rated the quality of the
evidence as very low for all outcomes and have not included the results
of individual studies here. We do not have enough evidence to draw
conclusions about the effect of HBE during intensive care management of
people with TBI.The lack of consistency among studies, scarcity of data
and the absence of evidence to show a correlation between physiological
measurements such as ICP, CCP and clinical outcomes, mean that we are
uncertain about the effects of HBE during intensive care management in
people with severe TBI.Well-designed and larger trials that measure
long-term clinical outcomes are needed to understand how and when
different backrest positions can affect the management of severe TBI.
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