Articles
Standing with the assistance of a tilt table improves minute ventilation in chronic critically ill patients

https://doi.org/10.1016/j.apmr.2004.03.024Get rights and content

Abstract

Chang AT, Boots RJ, Hodges PW, Thomas PJ, Paratz JD. Standing with the assistance of a tilt table improves minute ventilation in chronic critically ill patients.

Objective

To investigate the effect of standing with assistance of the tilt table on ventilatory parameters and arterial blood gases in intensive care patients.

Design

Consecutive sample.

Setting

Tertiary referral hospital.

Participants

Fifteen adult patients who had been intubated and mechanically ventilated for more than 5 days (3 subjects successfully weaned, 12 subjects being weaned).

Intervention

Passive tilting to 70° from the horizontal for 5 minutes using a tilt table.

Main outcome measures

Minute ventilation (V̇e), tidal volume (V̇t), respiratory rate, and arterial partial pressure of oxygen (Pao2) and carbon dioxide (Paco2).

Results

Standing in the tilted position for 5 minutes produced significant increases in V̇e (P<.001) and produced both increases in respiratory rate (P<.001) and Vt (P=.016) compared with baseline levels. These changes were maintained during the tilt intervention and immediately posttilt. Twenty minutes after the tilt, there were no significant changes in ventilatory measures of V̇e, Vt, or arterial blood gases Pao2 and Paco2 compared with initial values.

Conclusions

Standing for 5 minutes with assistance of a tilt table significantly increased ventilation in critical care patients during and immediately after the intervention. There were no improvements in gas exchange posttilt. Using a tilt table provided an effective method to increase ventilation in the short term.

Section snippets

Participants

A consecutive sample of 16 subjects who met the clinical criteria to begin using tilting as part of PT management was recruited over a period of 8 months. One recruited subject did not complete the study protocol because of clinical deterioration; thus, a total of 15 subjects (11 men, 4 women), who were recruited from the ICU of a tertiary referral hospital, completed the study. The clinical criteria to commence tilting were subjects breathing spontaneously with supplemental oxygen (n=8) or

Results

Each subject’s admitting conditions and comorbidities are outlined in table 1. Blood gas measurements were recorded in only 11 subjects because of equipment complications (n=1) and lack of arterial cannular (n=3). Ventilatory measurements at 20 minutes after the tilting intervention were recorded only in 7 subjects because of time constraints placed by clinical staff. No adverse events occurred during the study, and all 15 subjects completed the 5-minute tilt intervention without deterioration

Discussion

Our results show that standing using the assistance of the tilt table at 70° from the horizontal produced a transient increase in ventilation in critically ill patients. This increase was associated with increases in both Vt and respiratory rate that were sustained immediately after the intervention.

Conclusions

This study showed the physiologic responses in the ventilatory system with an increase in V̇e, Vt, and respiratory rate after standing with the tilt table for 5 minutes without limb exercise in patients who had been ventilated for more than 5 days. This shows that passive tilting alone may affect ventilation, with changes in respiratory mechanics and FRC, which may be more pronounced when combined with other exercise programs in the tilted position. Our results, however, show that the tilt

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      While all outcome measures significantly improved in both groups, the results favoured the early verticalization group for the Disability Rating Scale and the Coma Recovery Scale Revised. A statistically significant increase in minute ventilation, tidal volume and respiratory rate was noted over a five-minute tilt-table standing period in 15 critically-ill patients [26]. Thirty minutes of tilt table standing in a sample of 23 patients was found to be safe and to improve levels of consciousness and maximum inspiratory pressures in a 2015 prospective cohort study [82].

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    Supported by the Australian Physiotherapy Association (Dorothy Hopkins Award), the Australian Federation of University Women (Daphne Elliot Bursary), the National Health and Medical Research Council of Australia, and a Sir Robert Menzies Allied Health Scholarship.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

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