Document Detail


Continuous lateral rotation therapy to prevent ventilator-associated pneumonia.
MedLine Citation:
PMID:  19789440     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN: Prospective, randomized, clinical study. SETTING: Three medical intensive care units of an university tertiary care hospital. PATIENTS: Patients were randomized to continuous lateral rotation therapy or standard care if they were mechanically ventilated for <48 hrs and free from pneumonia. Primary study end point was development of ventilator-associated pneumonia. Ventilator-associated pneumonia was defined as infiltrate on the chest radiograph plus newly developed purulent tracheal secretion plus increasing signs of inflammation. The diagnosis had to be confirmed microbiologically and required the growth of a pathogen >10(4) colony-forming units/mL in bronchoalveolar lavage. Radiologists were blinded to randomization whereas clinical outcome assessors were not. INTERVENTIONS: Rotation therapy was performed continuously in a specially designed bed over an arc of 90 degrees. Additional measures to prevent ventilator-associated pneumonia were equally standardized in both groups including semirecumbent position. MEASUREMENTS AND MAIN RESULTS: Ventilator-associated pneumonia frequency during the intensive care unit stay was 11% in the rotation group and 23% in the control group (p = .048), respectively. Duration of ventilation (8 +/- 5 vs. 14 +/- 23 days, p = .02) and length of stay (25 +/- 22 days vs. 39 +/- 45 days, p = .01) were significantly shorter in the rotation group. In a forward stepwise logistic regression model including the continuous lateral rotation therapy, gender, Lung Injury Score, and Simplified Acute Physiology Score II, continuous lateral rotation therapy just failed to reach statistical significance with respect to development of ventilator-associated pneumonia (p = .08). Intolerance to continuous lateral rotation therapy during the weaning phase was observed in 29 patients (39%). Mortality was comparable in both groups. CONCLUSIONS: Ventilator-associated pneumonia prevalence was significantly reduced by continuous lateral rotation therapy. Continuous lateral rotation therapy led to shorter ventilation time and length of stay. Continuous lateral rotation therapy should be considered in ventilated patients at risk for ventilator-associated pneumonia as a feasible method exerting additive effects to other preventive measures.
Authors:
Thomas Staudinger; Andja Bojic; Ulrike Holzinger; Brigitte Meyer; Marion Rohwer; Friederike Mallner; Peter Schellongowski; Oliver Robak; Klaus Laczika; Michael Frass; Gottfried J Locker
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  38     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-19     Completed Date:  2010-02-22     Revised Date:  2010-03-02    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  486-90     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria. thomas.staudinger@meduniwien.ac.at
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MeSH Terms
Descriptor/Qualifier:
Female
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Motion Therapy, Continuous Passive*
Pneumonia, Ventilator-Associated / prevention & control*
Prospective Studies
Respiration, Artificial / adverse effects*
Rotation
Comments/Corrections
Comment In:
Crit Care Med. 2010 Feb;38(2):706-7   [PMID:  20083936 ]
Crit Care Med. 2010 Mar;38(3):1018-9; author reply 1019   [PMID:  20168183 ]

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