what do u think by using tilt table for patient SCI which still in ICU due to muscle insufficient??

[leepeiwoon]

hello everybody
i m pei woon from malaysia
currently there was a SCI patient who suffering trauma from C3-C7 and now was on halovast
he was admitted into ICU for almost 1 month and doctor can't wean the ventilation due to patient can't breathe by himself fully
they keep changing patient ventilation mode between CPAP and SIMV
they do try to put patient into trachy mask but patient was descent after half an hour
they think patient was having muscle insufficient.
breathing pattern of he is paradoximal breathing pattern

this patient has sensation back after 3 weeks of trauma at both upper limb but very minimal
light touch test done , patient able to felt untill level T2 but only 5% if compared to the face which 100%
proprioception was intact but patient can't tell exact position, he only know it is moving
he also able to perform shoulder shrug for left but no for rt

so question is , do u guys think tilt table can help this patient ?
in malaysia , i haven't saw any SCI cases with ventilation was treat with tilt table and i try to find journal online, still think there is limited literature about it.
most people use tilt table for people who are not SCI patient but neurological patient and get a good outcome


so can anybody pls tell me about this method if u guys have try it before??
what should i concern when i m doing this?
is it suitable ? why?
thanks lots for your help!!

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[OBUPhysio]

Pei,

I'm not 100% sure what you are trying to achieve with the tilt table, improved ventilation or initiating rehab?

If there is no medical reason to prevent the patient from sitting out of bed, perhaps attempt a hoist transfer into a wheelchair; ensuring adequate seating assessment and may require a strap around the thorax to aid stability in the chair (Initially attempt 30min-1 hour with close supervison and pressure relieving of 2 minutes in forward lean). The patient with injury above T6 will have parasympathetic dominance & therefore at risk of fainting/hypotension. Would therefore be vital to liaise with the medical team regarding a drug similar to or Ephedrine to help minimise BP drop whilst also using an abdominal binder to maintain VR.

As for ventilation, are you aware that in tetraplegic patients supine increases vital capacity by 12% due to gravity stabilising the ribcage and the abdominal contents moving cephalad, meaning that the diaphragm is in a greater resting position aiding excursion. If weaning is being trialed, the PVA link below has a document 'Respiratory management in SCI' which has a weaning guide. You may find that the patient will benefit from some sort of inspiratory muscle training during a treatment session in order to increase their chances of succeeding with their wean.

I hope this helps, the patient will need extensive rehab however, I'm not sure tilt tabling in the ICU is the first priority. Attempt sitting out in a w/chair whilst attached to the vent. When the patient is able to sit out without complication for 4 hours, then maybe attempt Tilt Tabling.

A