Acute hemodynamic responses to 30° head-down postural drainage in stable, ventilated trauma patients: a randomized crossover trial.

To determine whether 30° head-down tilt (HDT) used for secretion clearance is safe for acute trauma patients.There are concerns that HDT may lead to cardiac irregularities in intubated patients in the ICU.Eleven mechanically ventilated trauma patients (25-42 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.Compared to baseline there were statistically significant (p < 0.05) increases in SBP (6.3 mm Hg; 95% CI 2.5, 12.7) and CVP (7.3 cm H2O; 5.7, 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.30° HDT entails minimal risk for trauma patients who have no underlying cardiovascular disease.