[Positioning therapy in intensive care medicine in Germany. Results of a national survey].

BACKGROUND

The effects of a systematic change in a patient's position [prone position, continuous lateral rotational therapy (CLRT)] have been investigated in recent years in acute lung injury and have shown an improvement in oxygenation, but controversial results regarding duration of mechanical ventilation, intensive care treatment and mortality compared to conventionally treated patients. We were interested in the practice and acceptance of positioning therapy in German intensive care units (ICU) and performed a national postal survey with respect to evaluation of indications, preference of particular positions, observed complications and additional aspects (costs, influence on other intensive care measures etc.).

METHODS

A questionnaire (12 multiple choice items) was sent to 1,763 ICUs, which were identified from the "Deutsches Krankenhausadressbuch" (German hospital address book 2005). The analysis was performed anonymously.

RESULTS

A total of 702 questionnaires (40.4%) were returned and analysed. The 135 degrees position (incomplete prone position) was most frequently used (50%), while the prone position (25%) and CLRT (18%) were less frequent. The improvement in oxygenation (95%) and the prevention of ventilator-associated complications (75.7%) were important indications for positioning therapy. Results of a blood gas analysis provided the necessary criteria for determining positional therapy. Supporters of the prone position advocated lower cost and better efficacy in comparison to CLRT. The frequency of complications during positioning therapy was reported to be high: hemodynamic instability (73.6%), accidental loss of tube/catheters (50.4%) and patient intolerance (40.7%) were often observed, and complication-free positioning therapy was reported in only 8.6%.

CONCLUSIONS

The 135 degrees position (incomplete prone position) is the most frequently used positioning therapy in Germany for improvement of oxygenation in patients with acute lung injury. Prone position and CLRT are less frequently used, probably due to an increased frequency of (expected) complications. The authors assume that clear guidelines and algorithms are needed to establish a more routine, safe practical application and a reduction in the complication rate.