Effect of the Position of the Patient's Head

Study Overview
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Brief Summary
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The position of the head of the patient influences the cerebral venous return and cerebral perfusion pressure (CPP). In our daily practice, it is almost routine to prescribe a Trendelenburg position 30 ° in all brain-damaged patients. However, this is based only on precarious bibliographic databases. It has been shown to decrease the Intracranial Pressure (ICP) in Trendelenburg position relative to the horizontal, with varying effects on PPC. Effects on sylvian objectified by Doppler velocities and cerebral oxygenation seem unaffected by changes of position of the head of the patient. But the whole of the literature on this subject has significant bias.

Detailed Description
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Registration of blood flow changes induced when the patient's head will be tilted at 0 ° (that is to say flat), 15 ° and 30 ° (the order of actions will be determined by randomization). The patient will remain 10 minutes in each of these positions and will also have a little extra blood sample of 1 ml (ie 9 samples). These measures will be carried out again the next day and then after five days to see if the results vary depending on the evolution of his condition.

Official Title
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Study of the Effect of the Position of the Patient's Head With Brain Lesions on Cerebral Blood Flow

Conditions
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Brain Lesion

Intervention / Treatment
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* Procedure: position changes of the head


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged over 18 years with: A severe head injury or subarachnoid hemorrhage before the 5th day of evolution or spontaneous intracranial hematoma or ischemic stroke Neurosurgical Patients after surgery Presenting intracranial hypertension Exclusion Criteria: Hemodynamic and / or neurological instability. In the most unstable patients, care and mobilizations are reduced to a minimum. Craniectomy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| position changes of head with brain lesion<br>patient with position changes of the head: registration of blood flow changes induced when the patient's head will be tilted at 0 ° (that is to say flat), 15 ° and 30 °. | Procedure: position changes of the head<br>* Registration of blood flow changes induced when the patient's head will be tilted at 0 ° (that is to say flat), 15 ° and 30 ° (the order of actions will be determined by drawing lots). The patient will remain 10 minutes in each of these positions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebral oxygenation | Value of cerebral oxygenation (Hg mm) after 5 minutes in each position | day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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brain lesion, intracranial pressure, cerebral perfusion pressure