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Acute hemodynamic responses to 30 degrees head-down postural drainage in stable, ventilated trauma patients: a randomized crossover trial
Hongrattana G, Reungjui P, Jones CU
Heart & Lung 2014 Sep-Oct;43(5):399-405
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine whether 30 degrees head-down tilt (HDT) used for secretion clearance is safe for acute trauma patients. BACKGROUND: There are concerns that HDT may lead to cardiac irregularities in intubated patients in the ICU. METHODS: Eleven mechanically ventilated trauma patients (25 to 42 yrs) without cardiovascular problems received two interventions, one supine HDT for 10 min and a control in the horizontal supine position (HS), in a crossover design. RESULTS: Compared to baseline there were statistically significant (p < 0.05) increases in SBP (6.3 mmHg; 95% CI 2.5 to 12.7) and CVP (7.3 cmH2O; 5.7 to 10.0) during 10 min HDT although these were not of clinical concern. Heart rate and oxygen saturation were unchanged. No episodes of arrhythmia or hypoxemia were observed. All values returned close to baseline during 10 min horizontal recovery. There were no significant changes during the control HS intervention. CONCLUSION: 30 degrees HDT entails minimal risk for trauma patients who have no underlying cardiovascular disease.

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