Annals of SBV

Register      Login

VOLUME 4 , ISSUE 1 ( Jan-Jun, 2015 ) > List of Articles

Postural changes in Hemodynamically Unstable Patients in Critical Care Unit

A Kripa Angeline, R. Vijayaraj, V Manopriya

Keywords : Hemodynamic instability, Progressive mobility, Repositioning

Citation Information : Angeline AK, Vijayaraj R, Manopriya V. Postural changes in Hemodynamically Unstable Patients in Critical Care Unit. 2015; 4 (1):43-48.

DOI: 10.5005/jp-journals-10085-4109

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2015; The Author(s).


In the critical care population, heart rate and rhythm, blood pressure, respiratory rate, and oxygen saturation are monitored continuously, providing immediate feedback regarding any changes in patient status. Hemodynamic instability is a term commonly used by clinicians to describe labile changes in cardiopulmonary status. The clinician's perception of hemodynamic instability may cause a delay or omission in turning, repositioning, and other interventions to advance patient mobility and may contribute to pressure ulcer formation. The intensive care unit's practice culture and individual clinician perceptions regarding hemodynamic instability may lead to staff not turning patients out of fear that they are “too unstable to turn.”Critical care personnel determine the quality of patient care and patient outcomes. Interdisciplinary care is based on a comprehensive approach that includes standards and guidelines consistent with high quality evidenced based care.

PDF Share
  1. Joanne V. Hickey (2009) The clinical practice of Neurological and Neurosurgical Nursing, 6th edition Wolters Kluwer publications: Philadelphia.
  2. McGee S, Abernethy WB, 3rd, Simel DL. The rational clinical examination. is this patient hypovolemic JAMA. 1999;281:1022-1029
  3. Jonathan Sevransky Clinical Assessment of Hemodynamically Unstable Patients Curr Opin Crit Care 2009. June: 15 (3)234- 238.
  4. Porkorny M, Koldjeski D, Swanson M. Skin care intervention for patients having cardiac surgery. Am J Crit Care. 2003; 12: 535-544.
  5. Solis L, Gyawali S, Seres P, et al. Effects of intermittent electrical stimulation on superficial pressure, tissue oxygenation and discomfort levels for the prevention of deep tissue injury. Ann Biomed Eng. 2011; 39 (2): 649-663.
  6. Kathleen M. Vollman Hemodynamic Instability: Is It Really a Barrier to Turning Critically Ill Patients?2012;32:70-75 doi: 10.4037/ccn2012765Crit Care Nurse Published online © 2012 American Association of Critical-Care Nurses
  7. De Laat EH, Pickkers P, Schoonhoven L, Verbeek AL, Feuth T, van Achterberg T. Guideline implementation results in a decrease of pressure ulcer incidence in critically ill patients. Crit Care Med. 2007; 35 (3): 815-820.
  8. Offner PJ, Haenel JB, Moore EE, Biff WL, Franciose RJ, Burch JM. Complications of prone ventilation in patients with multisystem trauma with fulminant acute respiratory distress syndrome. J Trauma. 2000; 49 (4): 791-792. Crit Care. 2009; 20 (3): 254-266.
  9. De Jonghe B, Lacherade JC, Shashar T, Outin H. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med. 2009; 37 (10): s309-s315.
  10. Bailey P, Thomsen GE, Spuhler VJ, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007; 35 (1): 139-145.
  11. Lingren M, Unosson M, Fredrikson M, Ek AC. Immobility a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scand J Caring Sci. 2004; 18: 57-64.
  12. Gattinono L, Brazzi L, Pelosi P, Latini R, Togoni G, Pesenti A: A trial of goal-oriented hemodynamic therapy in critically ill patients N Engl J Med 1995
  13. Ledwith MB, Bloom S, Maloney-Wilensky E, Coyle B, Polomano RC, Le Roux PD Effect of body position on cerebral oxygenation and physiologic parameters in patients with acute neurological conditions Neuro Intensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
  14. Department of Health (202) Available adult critical care beds at 16 july 2002. Department of Health Forum KH03.
  15. Department of Health, Social Services and Public Safety, Northern Ireland (2000) Facing the future: building on the lessons of winter 1999/2000.
  16. Pronovost P, Dang G, Dorman T, Garrett E, Jenckes M, Bass E (2001) Intensive Care Unit nurse staffing and the risk of complication abdominal aortic surgery, Effective clinical practice 199-206.
  17. Peerless JR, Davies A, Kelin D, Yu D Skin complications in the Intensive Care Unit. Clin Chest Med. 1999;20(2):453- 467.
  18. Offner PJ, Haenel JB, Moore EE, Biff WL, Franciose RJ, Burch JM. Complications of prone ventilation in patients with multi system trauma with fulminant acute respiratory distress syndrome. J Trauma 2000:49(4):791-792.
  19. National Pressure Ulcer Advisory panel. Position statement: not all pressure ulcers are avoidable. march, 2010.
  20. Griffiths RD, Hall JB Intensive Care Unit Acquired Weakness. Crit Care Med. 2010;38(3):779-787.
  21. Rochester C Rehabilitation in the Intensive Care Unit. Semin Respir Crit Care Med. 2009;30:656-669.
  22. Zack MB, Pontoppidan H, Kazemi H. The effects of lateral positions on gas exchange in pulmonary disease. Am Rev Respir Dis. 1974;110:49-55.
  23. Katz JK, Barash PG. Positional hypoxemia followingposttraumatic pulmonaryinsufficiency. Can Anaesth, Soc J. 1977;24:346-352.
  24. AICU Consultant Jonathan Chantler, Senior Sister Carolyn Soanes AICU/CICU guidelines for Prone Ventilation in Severe Hypoxic ARDS Version 2 Issue Date:- March 2014
  25. Sreenandh Krishnagopalan, MD; E. William Johnson, MPH et al Body positioning of intensive care patients: Clinical practice versus standards* Critical Care Medicine 2002 Vol. 30, No. 11 pp 2588-259
  26. Karen L. Johnson, Tim Meyenburg, Physiological Rationale and Current Evidence for Therapeutic Positioning of Critically Ill Patients, AACN Advanced Critical Care Volume 20, Number 3, pp.228-240
  27. Defloor T. The effect of position and mattress on interface pressure. Appl Nurs Res. 2000;13:2-11.
  28. Ratliff CR, Bryant DE. Guidelines for the Prevention and Management of Pressure Ulcers. Glenview, IL: Wound, Ostomy, and Continence Nursing Society; 2003. WOCN Clinical Practice Guideline 2.
  29. Chatte G, Sab JM, Dubois JM, Sirodot M, Gaussorgues P, Robert D. Prone position in mechanically ventilated patients with severe respiratory failure. Am J Respir Crit Care Med. 1997;155:473-478.
  30. Theaker C. Pressure sore prevention in the critically illwhat you don't know, what you should know and whyit's important. Intensive Crit Care Nurs. 2003;19:163-168.
  31. Ibanez J, Penafiel A, Raurich JM, Marse P, Jorda R, Nata F. Gastroesophageal reflux in intubated patients receivingenteral nutrition: effect of supine and semirecumbentpositions. JPEN J Parenter Enteral Nutr. 1992;16:419-422.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.