Ahrens Thomas, Kollef Marin, Stewart Jena, Shannon William
Barnes-Jewish Hospital, St. Louis, MO, USA.
Am J Crit Care. 2004 Sep;13(5):376-83.
Optimal turning of critically ill patients is not well established. Kinetic therapy (systematic mechanical rotation of patients with 40 degree turns) may improve pulmonary function more than the improvement in function achieved via the standard of care (turning patients every 2 hours).
To determine (1) if patients receiving mechanical ventilation who tolerate kinetic therapy have better pulmonary function than do patients treated with standard turning and (2) the cost-effectiveness of kinetic therapy.
A prospective, randomized, multicenter study including 234 medical, surgical, and trauma patients (137 control patients, 97 patients receiving kinetic therapy).
Kinetic therapy significantly decreased the occurrence of ventilator-associated pneumonia and lobar atelectasis. The risk of pneumonia developing was lower (P = .002) in patients receiving kinetic therapy than in the control patients. The risk of lobar atelectasis developing was decreased (P = .02) for the patients receiving kinetic therapy. Lengths of stay in the intensive care unit and in the hospital did not differ between the groups. Charges for intensive care were less in the kinetic therapy group (81,700 dollars) than in the control group (84,958 dollars), but not significantly less. Twenty-one patients did not tolerate kinetic therapy and were not included in the analysis.
Kinetic therapy helps prevent ventilator-associated pneumonia and lobar atelectasis in critically ill patients. Costs to rent the bed may be offset by the potential cost reduction associated with kinetic therapy.
危重症患者的最佳翻身方案尚未明确。动态治疗（将患者进行40度系统性机械转动）可能比常规护理（每2小时为患者翻身）更能改善肺功能。
确定（1）接受机械通气且能耐受动态治疗的患者的肺功能是否优于接受常规翻身治疗的患者，以及（2）动态治疗的成本效益。
一项前瞻性、随机、多中心研究，纳入234例内科、外科和创伤患者（137例对照患者，97例接受动态治疗的患者）。
动态治疗显著降低了呼吸机相关性肺炎和肺叶肺不张的发生率。接受动态治疗的患者发生肺炎的风险低于对照患者（P = 0.002）。接受动态治疗的患者发生肺叶肺不张的风险降低（P = 0.02）。两组患者在重症监护病房和医院的住院时间无差异。动态治疗组的重症监护费用（81,700美元）低于对照组（84,958美元），但差异不显著。21例患者不耐受动态治疗，未纳入分析。
动态治疗有助于预防危重症患者的呼吸机相关性肺炎和肺叶肺不张。租用床位的费用可能会被动态治疗带来的潜在成本降低所抵消。
