Wang Jann-Yuan, Chuang Pao-Yu, Lin Chun-Ju, Yu Chong-Jen, Yang Pan-Chyr
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2003 Nov;102(11):788-92.
The efficacy of continuous lateral rotational therapy (CLRT) for mechanically ventilated patients is not well established. This study investigated the effect of CLRT on gas exchange and the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients in a medical intensive care unit (ICU).
Thirty five mechanically ventilated patients in a medical ICU received CLRT for 5 days, while 35 control patients matched for age, gender, cause of respiratory failure, and admission Acute Physiology and Chronic Health Evaluation (APACHE) score, received routine positional change. The results of blood gas analysis, incidence of VAP, findings on chest radiograph, length of ICU stay, and sputum characteristics were recorded.
Greater improvement in oxygenation index (the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) was noted in the patients who received CLRT (31 +/- 42 vs 6 +/- 76, p = 0.03). Patients who received CLRT also had lower VAP incidence (0 vs 5, p < 0.001), were more likely to have improvement in pulmonary infiltrates (17 vs 12, p = 0.04) and had shorter ICU stay (22 +/- 8 days vs 27 +/- 12 days, p = 0.09). The ICU discharge status (dead, ventilator dependent, alive) was not significantly different between the 2 groups.
Mechanically ventilated patients in the medical ICU who received CLRT had improved oxygenation and reduced incidence of VAP compared to controls.
持续侧方旋转治疗（CLRT）对机械通气患者的疗效尚未明确。本研究调查了CLRT对内科重症监护病房（ICU）中机械通气患者气体交换及呼吸机相关性肺炎（VAP）发生率的影响。
35例内科ICU的机械通气患者接受了5天的CLRT治疗，而35例年龄、性别、呼吸衰竭病因及入院急性生理与慢性健康状况评分（APACHE）相匹配的对照患者接受常规体位改变。记录血气分析结果、VAP发生率、胸部X线检查结果、ICU住院时间及痰液特征。
接受CLRT治疗的患者氧合指数（动脉血氧分压与吸入氧分数之比）改善更明显（31±42 vs 6±76，p = 0.03）。接受CLRT治疗的患者VAP发生率也更低（0 vs 5，p < 0.001），肺部浸润改善的可能性更大（17 vs 12，p = 0.04），ICU住院时间更短（22±8天 vs 27±12天，p = 0.09）。两组间ICU出院状态（死亡、依赖呼吸机、存活）无显著差异。
与对照组相比，内科ICU中接受CLRT治疗的机械通气患者氧合改善，VAP发生率降低。
