Passive orthostatism in comatose patients in a critical care unit
A preliminary report
DOI:
https://doi.org/10.34024/rnc.2008.v16.8658Keywords:
Cerebrovascular accident, Orthostatic hypotension, Glasgow Coma Scale, PrognosisAbstract
Objective. To verify if the level of conscience evaluated through the Glasgow Coma Scale (GCS) can be influenced by the orthostatic position. Methods. 7 patients had participated in this research (6 male and 1 female), with diagnosis of isquemic stroke in the critical unit care. Hemodynamically unstable patients have been excluded, with artificial airmail adding 11 points in (GCS) and not sedative for at least 48 hours. The patients were submitted to orthostatism and the vital data were monitored during all the procedure. Conscience level was evaluated through the Glasgow Coma Scale in the position of dorsal decubitus, 1st minute of orthostatism, after the 15th minute of orthostatism, and in the return to dorsal position. Results. The score of the GCS increased in the first minute and stabilized during the period of orthostatism (p < 0.011). Conclusion. The GCS seems to be influenced by the assisted orthostatism.
Metrics
References
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-4.
Karma D, Rawat AK. Effect of stimulation in coma. Indian Ped 2006;43:856-60.
Oh H, Seo W. Sensory stimulation programme to improve recovery in comatose patients. J Clin Nurs 2004;13:125-7.
Chang TA, Boots R, Hodges WP, Paratz J. Standing with assistance of a tilt table in intensive care: Asurvey of Australian physiotherapy practice. Aus J Physiother 2004;50:51-4.
Elliott L, Coleman M, Shiel A, Wilson BA, Badwan D, Menon D, et al. Effect of posture on levels of arousal and awareness in vegetative and minimally conscious state patients: a preliminary investigation. J Neurol Neurosur Psychiatr 2005;76:298-9.
Quigley MR, Vidovich D, Cantella D, Wilberger JE, Maroon JC, Diamond D. Defining the limits of survivorship after very severe head injury. J Trauma 1997;42:7-10.
Melo TRJ, Filho OJ, Silva AR, Júnior MDE. Fatores preditivos do prognóstico em vítimas de trauma cranioencefálico. Arq Neuropsiquiatr 2005;63:1054-7.
Treger I, Shafir O, Keren O, Ring H. Orthostatic hypotension and cerebral blood flow velocity in the rehabilitation of stroke patients. Int J Rehabil Res 2006;29:339-42.
Elliott L, Walker L. Rehabilitation interventions for vegetative and minimally conscious patients. Neuropsychol Rehab 2005;15:480-93.
Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke. Stroke 2002;33:497-501.
Blissitt PA. Hemodynamic monitoring in the care of the critically ill neuroscience patient. AACN. Adv Crit Care 2006;17:327-40.
Sosnowski C, Ustik M. Early intervention: Coma stimulation in the Intensive Care Unit. J Neurosci Nurs 1994;26: 336-41.
