Ambulation was mTOR inhibitor started with a walking frame with full support, and the patient referred to geriatric inpatient for further physiotherapy management. Discussion Using tilt table for early rehabilitation of patients in ICU is a new trend of practice

among the therapists. A recent study had reported that early mobility in the ICU is safe, and can cause a significant decrease in short-term physical Inhibitors,research,lifescience,medical impairment.3 In our patient, we attempted early mobility for the patient using tilting table, a significant modern technique from our routine practice. In conventional physiotherapy practice, early mobilization is tried at the bedside by active assisted and active limb exercises. Besides, a therapist has to wait for many days until a patient can sit up unsupported before starting to train them for standing balance or some functional activities. So in traditional approach, the prolonged Inhibitors,research,lifescience,medical bed rest complications might not be addressed effectively. However, tilting the patient stimulated a more functional movement and weight bearing pattern, improved the aerobic system, improved the gaseous exchange, and more likely contributed to the weaning the patient Inhibitors,research,lifescience,medical from the ventilator. The present case report stresses the benefits of using a tilt table, which prompts standing in a faster and better manner than other approaches. We suggest that even a weak and exhausted patient could

be considered for vertical positioning as long as the vital signs such as blood pressure, pulse rate Inhibitors,research,lifescience,medical and arterial gas saturation are stable.6 This technique also gave the therapist more freedom to easily perform other exercises for the patient, since the therapist is no longer needed to support the patient. Inhibitors,research,lifescience,medical We think that it might even reduce the rate of

musculoskeletal disorders met by the therapist in ICU practice. To discuss the clinical reasoning of the tilt table management in ICU, recent studies stated there was improvement in the capillary membrane permeability, minute ventilation, and increased energy spending among patients in upright standing posture.7,8 This could be the possible reason for the change in the ventilatory features, which in turn leads to a better gas exchange. Zafiropoulous tuclazepam and colleagues believed that the betterments in physiologic changes were thought to be largely due to positional changes from supine to standing.9 The findings of the present case report are similar to those of an earlier report,5 in which patients, who had been ventilated for more than five days, were exposed to tilt table standing at 70 degrees from the horizontal for five minutes.5 The study showed that the patient’s tidal and minute ventilation increased significantly but temporarily.5 However, there is no documented randomized control trials that has examined the therapeutic benefits of using tilt table in an ICU setting.