Department of Internal Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria.
Crit Care Med. 2010 Feb;38(2):486-90. doi: 10.1097/CCM.0b013e3181bc8218.
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.
Prospective, randomized, clinical study.
Three medical intensive care units of an university tertiary care hospital.
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.
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.
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.
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.
探讨预防性连续侧卧旋转治疗对重症医学科机械通气患者呼吸机相关性肺炎（VAP）的发生率、机械通气时间、住院时间和死亡率的影响。
前瞻性、随机、临床研究。
一所大学三级保健医院的 3 个内科重症监护病房。
如果患者机械通气时间<48 小时且无肺炎，则将其随机分配至连续侧卧旋转治疗或标准护理。主要研究终点为呼吸机相关性肺炎的发生。呼吸机相关性肺炎定义为胸片浸润+新出现脓性气管分泌物+炎症标志物增加。诊断必须通过微生物学确认，并要求支气管肺泡灌洗液中病原体的生长>10(4)个菌落形成单位/ml。放射科医生对随机分组不知情，而临床结局评估者知情。
在专门设计的床上以 90 度的弧形连续进行旋转治疗。两组均采用同样的半卧位等标准措施预防呼吸机相关性肺炎。
重症监护病房期间，旋转治疗组 VAP 发生率为 11%，对照组为 23%（p=0.048）。旋转治疗组的通气时间（8+/-5 天与 14+/-23 天，p=0.02）和住院时间（25+/-22 天与 39+/-45 天，p=0.01）均显著缩短。在包括连续侧卧旋转治疗、性别、肺损伤评分和简化急性生理学评分 II 的向前逐步逻辑回归模型中，连续侧卧旋转治疗在发生呼吸机相关性肺炎方面仅未达到统计学显著性（p=0.08）。在脱机阶段，29 例（39%）患者对连续侧卧旋转治疗不耐受。两组死亡率相当。
连续侧卧旋转治疗可显著降低呼吸机相关性肺炎的发生率。连续侧卧旋转治疗可缩短通气时间和住院时间。对于有呼吸机相关性肺炎风险的机械通气患者，应考虑连续侧卧旋转治疗，作为一种可行的方法，可与其他预防措施联合使用，发挥附加作用。
