We evaluated arterial oxygen saturation (SaO2) and heart rate in acute stroke patients to determine whether routine positioning affected these physiological parameters. Measurements were recorded at the bedside non-invasively in five different positions assigned in random order each maintained for 10 min. One hundred and twenty-nine patients examined within a median of 72 h, lying on the left side resulted in slightly lower SaO2 than lying on the right side, which was statistically significant in the patients with a right (n = 66), but not left, hemiparesis. Patients able to sit in a chair (n = 65), who mostly had less severe strokes, had a significantly higher mean SaO2 and heart rate when sitting in the chair than when placed in any other position. About 10% of patients, especially those with a severe stroke, with right hemiparesis and concomitant chest disease, experienced falls in SaO2 to 90% or less for ≧2 min in certain positions; the hypoxia was more likely when they were lying on their left side. These results may have implications for current practice and for future patient positioning strategies to improve outcome after stroke.

Keywords:
Positioning, Acute stroke, Hemiparesis, Arterial oxygen saturation, Heart rate
1.
Lasater-Erhard M: The effect of patient position on arterial oxygen saturation. Crit Care Nurse 1995;15:31–36.
2.
Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: A randomised controlled trial. Lancet 1999;354:1851–1858.
3.
Bratina P, Rapp K, Barch C, Kongable G, Donnarumma R, Spilker J, Daley S, Braimah J, Sailor S: Pathophysiology and mechanisms of acute ischemic stroke. The NINDS rt-PA stroke study group. J Neurosci Nurs 1997;29:356–360.
4.
Pang PA, Yeung VTF, Zhang YG: Do postural changes affect gas exchange in acute hemiplegia? Br J Clin Pract 1988;42:501–502.
5.
Elizabeth J, Singarayar J, Ellul J, Barer D, Lye M: Arterial oxygen saturation and posture in acute stroke. Age Ageing 1993;22:269–272.
6.
Walshaw MJ, Pearson MG: Hypoxia in patients with acute hemiplegia. BMJ 1984;288:15–17.
7.
WHO (World Health Organisation): Cerebrovascular Disorders: A Clinical and Research Classification. Geneva, World Health Organization, 1998, pp 43.
8.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C: Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–1526.
9.
Alexander CM, Teller LE, Gross JB: Principles of pulse oximetry, theoretical and practical considerations. Anesth Analg 1989;68:368–376.
10.
Howells T, Signorini DF, Jones PA, Andrews PJD, Piper IR, Teasdale GM, Contant CF, Robertson CS, Czosnyka M, Piechnik S, Pickard JD: A multi-centre database for multimodality clinical monitoring (abstract). Am J Med Sci 1997;4–142.
11.
Zaidi NH, Smith HA, King SC, Park C, O’Neill PA, Connolly MJ: Oxygen desaturation on swallowing as a potential marker of aspiration in acute stroke. Age Ageing 1995;24:267–270.
12.
Bassetti C, Aldrich MS, Chervin RD, Quint D: Sleep apnea in patients with transient ischaemic attack and stroke: A prospective study of 59 patients. Neurology 1996;47:1167–1173.
13.
Good DC, Henkle JQ, Gelber D, Welsh J, Verhulst S: Sleep-disordered breathing and poor functional outcome after stroke. Stroke 1996;27:252–259.
14.
Nunn JF: Respiratory dead space and distribution of the inspired gas. In Nunn JF (ed): Applied Respiratory Physiology. London, Butterworths, 1977, pp 213–245.
15.
Svanberg L: Influence of posture on lung volumes, ventilation and circulation in normals. Scand J Clin Lab Invest 1957;9:16.
16.
Alexander MSM, Arnot RN, Lavender JP: Left lower lobe ventilation and its relation to cardiomegaly and posture. BMJ 1989;299:94–95.
17.
Lavender JP, Peters AM: Regional ventilation in the prone position. Lancet 1997;350:1177.
18.
Hough A: Physiotherapy in Respiratory Care – A Problem-Solving Approach. London, Chapman and Hall, 1991.
19.
Bassetti C, Aldrich MS: Sleep apnea in acute cerebrovascular diseases. Final report on 128 patients. Sleep 1999;22:217–223.
20.
Gawlinski A: Effect of positioning on mixed venous oxygen saturation. J Cardiovasc Nurs 1993;7:71–81.
21.
Shively M: Effect of position change on mixed venous oxygen saturation in coronary artery bypass surgery patients. Heart Lung 1988;17:51–59.
22.
Winslow EH, Clark AP, White KM, Tyler DO: Effects of a lateral turn on mixed venous oxygen saturation and heart rate in critically ill adults. Heart Lung 1990;19:557–561.
23.
Rønning OM, Guldvog B: Should stroke victims routinely receive supplementary oxygen? A quasi-randomised controlled trial. Stroke 1999;30:2033–2037.
© 2001 S. Karger AG, Basel
2001
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.