Passive orthostatism (tilt table) in critical patients: Clinicophysiologic evaluation

Abstract

Purpose: To assess the effects of passive orthostatism on various clinicophysiologic parameters of adult intensive care unit (ICU) patients, by daily placement on a tilt table.

Materials and methods: This prospective cohort study was performed in a general ICU. Twenty-three patients 18 years or older, intubated or tracheostomized, without sedation and under weaning from mechanical ventilation, were analyzed. All variables were evaluated at tilting of 30°, 45°, 60°, 75°, and 90°.

Results: Glasgow Coma Scale increased during tilt in the first and second day, as well as Richmond Agitation-Sedation Scale. No significant differences were detected in the physiological parameters; however, there was a nonsignificant decrease on the mean arterial pressure at angles of 75° and 90°. The maximum inspiratory pressure significantly increased at 60° compared with 30° on day 1 of the intervention. No significant differences were observed for maximum expiratory pressure, rapid shallow breathing index, and the tidal volume.

Conclusion: A protocol with daily use of a tilt table for ICU patients is safe and improves the level of consciousness and inspiratory maximum pressure, without causing deleterious acute physiological effects.

Keywords: Early mobilization; Glasgow Coma Scale; Intensive care unit; Mechanical ventilation.