Trendelenburg As a First-line Intervention in Critically Ill, Sedated, Invasively Mechanically Ventilated, Hypotensive Patients: a Pilot Randomized Controlled Trial
A pilot randomized controlled trial to evaluate the efficacy and safety of Trendelenburg position in critically ill patients with hypotension, mainly patients with septic shock and post operative vasoplegia. The main aim is to assess whether Trendelenburg position can improve organ function through a reduction in the need of fluid infusion and dose of vasopressors. Patients will be screened for participation in the study and eventually randomized based on a balanced randomization scheme (1:1) to Trendelenburg position up to 72 hours after intensive care unit (ICU) admission or Semirecumbent position (standard of care).
• Age \>18 years
• Admitted to the intensive care unit (ICU);
• Invasive mechanical ventilation;
• Pharmacological sedation;
• Mean arterial pressure (MAP)\<65 mmHg or need of fluids infusion or any vasopressor in order to keep MAP \> 65 mmHg
• Ongoing invasive and/or non-invasive arterial blood pressure monitoring
• Central venous line with central venous pressure (CVP) monitoring
• Naso-gastric tube in situ
• Indwelling bladder catheter
• Consent according to local ethical committee rules