Haemodynamic effects of kinetic therapy in critically ill trauma patients

Background and objectives

The principles of kinetic theraphy and their positive effects on oxygenation have been well established in the last years. Less is known about the haemodynamic effects under continuous rotation in critically ill patients. Facts about the cardiac function, especially the cardiac output, are only based on single measurements with the Swan catheter.

Methods

We studied the effects of continuous rotating (Fig left) in 10 patients using the KCI Rotorest bed. All patients were rotated in 60° angulation. During the rotation continuous cardiac output (CCO) was measured with the Baxter Vigilance System. The data were collected and computerised during the whole time the Swan catheter was applied (mean time 4 days). The changes in cardiac output were measured in the printed hardcopies (eg Fig right) of the CCO curves.

Figure

Results

In 10 patients, 314 rotation cycles could be measured. A mean number of 32 rotations was measured for every patient. The mean difference in cardiac output (CO) was 700 ml per rotation cycle (100–3000 ml). The higher volumes of more than 2000 ml difference during single rotations were measured in two patients with a septic inflammatory response syndrome (SIRS), which had a CO of more than 12 1/min.

Conclusions

Kinetic therapy has an influence on the cardiac output in critically ill patients. The volume of the cardiac output change seems to correlate with the total CO so that patients with a stable haemodynamic situation have smaller volume changes than patients with a high CO, like in cases of SIRS or sepsis.