Available evidence suggests that in stroke patients without hypoxia or significant respiratory or pulmonary comorbidities, the supine or side position has minimal effect on oxygen saturation.371,374–377 Limited data suggest stroke patients with hypoxia or significant pulmonary comorbidities have lower oxygen saturation in the supine position than in upright positions.371,377 In patients who are able to maintain oxygenation while lying flat, the supine position may offer advantages in cerebral perfusion.372,373
Thus, in nonhypoxic patients able to tolerate lying flat, a supine position is recommended. Patients at risk for airway obstruction or aspiration and those with suspected elevated ICP378 should have the head of the bed elevated 15° to 30°. When patient position is altered, close monitoring of the airway, oxygenation, and neurological status is recommended, and adjustment to changing clinical parameters may be required.
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