Goldhill David R, Imhoff Michael, McLean Barbara, Waldmann Carl
The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
Am J Crit Care. 2007 Jan;16(1):50-61; quiz 62.
Immobility is associated with complications involving many body systems.
To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients.
Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses.
A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality.
Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.
活动受限与涉及多个身体系统的并发症相关。
综述旋转疗法（使用绕其纵轴转动的治疗床面）对危重症患者呼吸并发症的预防和/或治疗效果。
对已发表的评估预防和/或治疗效果的文章进行综述。对前瞻性随机对照试验进行质量评估并纳入荟萃分析。
文献检索得到15项非随机、无对照或回顾性研究。1987年至2004年间发表了20项关于旋转疗法的前瞻性随机对照试验。研究了各种类型的床，但关于旋转参数的细节报道很少。通常的对照是护士每2小时手动翻动患者。1项动物研究和12项临床试验探讨了旋转疗法预防呼吸并发症的有效性。动物研究和4项试验报告了显著益处。另外4项聚焦于已发生并发症治疗的研究中有2项报告了对患者有显著益处。研究人员研究了旋转疗法对黏液转运、肺内分流、血流动力学效应、尿量和颅内压的影响。然而，关于最有效的旋转参数（如角度、暂停时间和每天的旋转时间）几乎没有令人信服的证据。荟萃分析表明，旋转疗法可降低肺炎的发生率，但对机械通气时间、重症监护天数或医院死亡率无影响。
旋转疗法可能对部分接受机械通气的危重症患者预防和治疗呼吸并发症有用。
