ArticlesStanding with the assistance of a tilt table improves minute ventilation in chronic critically ill patients
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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2018, Journal of Critical CareCitation Excerpt :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.
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