Difference in physiological parameters between sitting out of bed into a chair or sitting up on an electric bed in the adult ICU
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KeywordsTidal Volume Physiological Parameter Cardiovascular Response Intensive Care Patient Physical Assessment
The primary aim of this study was to identify in adult intensive care patients whether there was a difference in the acute physiological response when a patient is sat out into a chair compared with when a patient is placed in a chair position using an electric bed. The secondary aim of this study was to observe the functional outcome of these patients .
The study was conducted in an adult tertiary referral ICU over a 3-month period. Patients that met predetermined inclusion/exclusion criteria were allocated to either sitting in a chair or sitting up in an electric bed. Heart rate, respiratory rate, tidal volume and mean arterial pressure were obtained for all patients when they were supine in bed, at 1 minute and at 1 hour in the new position. Arterial blood gases were obtained at 1 hour in their new position. A functional outcome measure known as the Chelsea Critical Care Physical Assessment Tool (CPAX) was also taken on the day of admission, on the day of sitting out, on the day of discharge from intensive care and at ward level. All data were analysed using Student's t test.
Sixteen subjects were recruited for this study. There was a significant increase in paO2 (13.6 ± 2.35 kPa, P = 0.01) and decrease in paCO2 (4.82 ± 1.27 kPa, P = 0.02) in the chair group at 1 hour after sitting out in the chair when compared with baseline (10.9 ± 2.44 kPa; 5.41 ± 1.32 kPa). Also there was a significant increase in tidal volume in the chair group after 1 minute of sitting out (403 ± 118 ml) compared with baseline (314 ± 105 ml). There was no difference in the electric bed group for all physiological parameters. The chair group had a better CPAX score on discharge from intensive care (chair group 24; electric bed group 13) and on discharge from the hospital (chair group 39; electric bed group 16). There were no adverse cardiovascular responses to either position.
Sitting suitable critically ill patients out into a chair is safe and can significantly improve the arterial blood gas measurement and the tidal volume when compared with sitting a patient into the sitting position in an electric bed.
This article is published under license to BioMed Central Ltd. This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2014 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2014. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.