Study on the Optimal Head Position for Patients With Severe Acute Ischemic Stroke

Stroke is the second leading cause of death and the third leading cause of disability worldwide, with an increasing incidence. Reperfusion therapy after cerebral ischemia is one of the most practical and effective treatments for ischemic stroke globally. However, the nursing care and management of hemodynamics during the acute phase after reperfusion therapy for ischemic stroke have always been key and challenging aspects of clinical work. Stable hemodynamic status can prevent hypoperfusion or hyperperfusion of brain tissue, reduce damage to the ischemic core and penumbra areas, and consequently decrease cerebral edema, elevated intracranial pressure, and the associated neurological damage and worsening clinical outcomes.

Head positioning, as a simple, economical, and effective adjunctive treatment for managing patients undergoing reperfusion therapy, has gradually received attention. During the acute phase of stroke, brain tissue is in a state of ischemia and hypoxia. Lying flat may increase blood and oxygen supply to the brain tissue, providing a certain degree of protection, but it may also have some impact on swallowing and lung function. Raising the head of the bed can help venous blood return from the head and may reduce cerebral edema to some extent, but it can also affect perfusion of ischemic brain tissue to a certain degree. In the acute phase after successful reperfusion, it remains a clinical challenge to maintain stable cerebral blood supply (hemodynamic stability) through nursing care. Head positioning (lying flat or elevating the head of the bed) is a simple, economical nursing measure that may affect cerebral blood flow. However, for severely affected stroke patients like you, there is no clear international consensus on whether maintaining a flat position (0°) or elevating the head of the bed 30° within the first 24 hours after treatment is more beneficial for long-term recovery. Previous studies have shown inconsistent results, so more rigorous research is needed to answer this question.

The primary purpose of this study is to determine that a 30° position during the acute phase of severe ischemic stroke is safe. The secondary purpose is to evaluate whether a 30° position in the acute phase improves 90-day outcomes compared to a 0° position (assessed using the modified Rankin Scale).

This study is a randomized controlled trial. This means you will be randomly assigned (like a coin toss) to one of the following two groups: Experimental group: within 24 hours of admission, maintain the head and bed elevated at 30°. Control group: within 24 hours of admission, remain completely flat (0°). Interventions and methods: Both head positions are commonly used basic nursing measures in neurological intensive care. Lying flat may help increase blood supply to the brain, while elevating the head of the bed may help reduce cerebral edema and the risk of aspiration. This study aims to scientifically compare which angle is better for your long-term recovery. Procedures: Research nurses will use a special angle ruler to ensure your head position is accurate. During the 24-hour intervention, we need you to maintain the assigned position as much as possible. Considering your comfort and necessary medical care (such as back patting and skin inspection), brief interruptions are allowed (no more than three times for the flat position group, with each interruption less than 30 minutes). Legal Compliance: Head positioning management is a routine nursing procedure. This study only conducted standardization and comparative research on it, and did not involve the use of any experimental drugs or high-risk devices. It has passed ethical review.

Study Overview

• Status: Not yet recruiting
• Conditions: Stroke Acute
• Intervention / Treatment: Behavioral: head position

• Study Type: Interventional
• Enrollment (Estimated): 1508
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: ling feng, Master's degree; Phone Number: 08618980602079; Email: fengling216@163.com

Study Locations

• China
  • Sichuan
    • Chengdu, Sichuan, China, 610041
      • West China Hospital, Sichuan University
      • Contact: ling feng, Master's degree; Phone Number: 18980602079; Email: fengling216@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria

1. Age ≥ 18 years
2. Meeting the diagnostic criteria for acute ischemic stroke according to the "Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2023": ①Acute onset, ②Focal neurological deficits, with a few having global neurological deficits, ③Imaging shows a corresponding lesion or symptoms/signs persist for more than 24 hours, ④Exclusion of non-vascular causes, ⑤Brain CT/MRI excludes cerebral hemorrhage
3. Meeting the criteria for severe ischemic stroke patients: severe neurological deficits at admission [for example, National Institutes of Health Stroke Scale (NIHSS) score≥15]
4. First-time diagnosed ischemic stroke patients who undergo thrombolysis and/or thrombectomy reperfusion treatment
5. Time from onset to randomization within 24 hours
6. Informed consent obtained and signed by the patient or their family

Exclusion Criteria

1. Known pregnancy or breastfeeding, or positive pregnancy test before randomization
2. Expected survival time less than 3 months (such as with malignant tumors, severe cardiopulmonary diseases, etc)
3. Already participating in other interventional clinical studies that may affect outcome assessment
4. Other situations deemed by the investigator as unsuitable for participation in this study or that may pose significant risks to the patient (such as inability to understand and/or comply with study procedures and/or follow-up due to mental illness, cognitive or emotional disorders)
5. Presence of brain midline shift or herniation, ventricular mass effect
6. Patients with limited head elevation (or patients unable to cooperate with postural intervention due to their condition/recovery needs, etc.)
7. Presence of respiratory infection symptoms such as fever, cough, or sputum production at the time of admission

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: 0-degree head position; Keep the head flat at 0° (completely lying down) for 24 hours. During this period, including eating and using the toilet, you must remain lying flat, but intermittent interruptions due to necessary nursing operations (such as back patting or skin checks) are allowed, not exceeding a total of 3 times, with each interruption ≤30 minutes.
Experimental: 30-degree head position; Raise the head of the bed by 30° and maintain for 24 hours. Use a standardized angle ruler and position cushion to ensure accuracy of the angle, bed head angle (including pillow)	Behavioral: head position; Raise the head of the bed by 30° and maintain for 24 hours. Use a standardized angle ruler and position cushion to ensure accuracy of the angle, bed head angle (including pillow)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Score of Modified Rankin Scale	Modified Barthel Index (MBI): is a measure of activities of daily living (ADL), which shows the degree of independence of a patient from any assistance. It is an important method used to evaluate the capacity of participants to conduct 10 different ADLs, considered basic ADLs, thus providing a quantitative estimation of their independence level. The mRS is an ordinal scale that ranges from 0 (no symptoms) to 6 (death).	day 90
Patient mortality	Patient mortality within 90 days, used for safety assessment	day 90

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Score of National Institutes of Health Stroke Scale reduced by ≥4 points	Neurological function improvement	5-7 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Chinese version of the European Quality of Life Measurement Scale	The Chinese version of the European Quality of Life Measurement Scale (EQ-5D) , which consisted of the EQ-5D descriptive system, the European Five Dimensions Questionnaire Visual Analogue Scale (EQ-VAS), and the utility index. The EQ-5D descriptive system measured participants' health status in three levels of severity (no problems, moderate problems, and extreme problems) with five dimensions: mobility (MO), self-care (SC), usual activities (UA), pain/discomfort (PD), and anxiety/ depression (AD) . The EQ-VAS score was recorded on a scale with anchor points 0 (worst health state) and 100 (best health state), which reflected patients' knowledge of health. A higher EQ-5D utility index indicated higher levels of QoL.	day 90
Incidence of pneumonia	Occurrence of pneumonia	Day 90
Serious adverse event	Safety evaluation, including aspiration, suffocation, pressure injuries, deep vein thrombosis, etc.	DAY 90

Collaborators and Investigators

• Sponsor: West China Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): April 30, 2029

Study Registration Dates

• First Submitted: March 23, 2026
• First Submitted That Met QC Criteria: March 29, 2026
• First Posted (Actual): April 2, 2026

Study Record Updates

• Last Update Posted (Actual): April 2, 2026
• Last Update Submitted That Met QC Criteria: March 29, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Posture; Head-Down Tilt
• Other Study ID Numbers: WestChinaH-neuro

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No