Hi! Thanks for your question. I had not seen it, but I have just reviewed it. I can't say I'm surprised... the impact (if any) of head positioning pales in comparison to actually opening the artery.
Dear Granat,
It is interesting to see the role of head positioning in outcome of stroke patients. The results of this study are avaible at https://www.ncbi.nlm.nih.gov/pubmed/28636854 and the investigators have concluded it does not make significant difference to the outcome.
https://www.ncbi.nlm.nih.gov/pubmed/28636854
It is apparent that "one size fits all" does not apply to head up/down positioning.
At the bedside, it is interesting to note that some patients do better with the increase in potential intracranial perfusion with the head down, while others do worse and develop headache or trouble swallowing.
This question has also been asked in regards to severe traumatic brain injury and the answer in my experience is the same; it depends.
When in doubt I guess we can let the patient decide, both by how he/she feels and by what his/her vital signs data are showing. One wonders how many times we force patients into uncomfortable positions when they are the sickest without knowing, ourselves, that we are really doing right by them.
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