Department of Medicine/Cardiology, Heart Center, Dresden University of Technology, Fetscherstr. 76, 01307, Dresden, Germany.
Clin Res Cardiol. 2012 Dec;101(12):955-62. doi: 10.1007/s00392-012-0484-7. Epub 2012 Jun 23.
Continuous lateral rotation ["Kinetic therapy" (KT)] has been shown to reduce complications and to shorten hospital stay in trauma patients. Data in non-surgical patients is inconclusive. Retrospective data suggest a beneficial effect of KT in patients with cardiogenic shock (CS) requiring ventilator therapy. KT, however, has not been tested prospectively in those patients.
A prospective, randomized, open-label trial was performed to compare KT using oscillating beds (TryaDyne Proventa, KCI) with standard care (SC). Patients with cardiogenic shock requiring ventilator therapy for more than 24 h were included. Primary endpoint was the occurrence of hospital-acquired pneumonia. Secondary endpoints were the occurrence of pressure ulcers during the hospital stay and 1-year all-cause mortality.
Forty-five patients were randomized to KT, and 44 to SC. All patients required at least one inotropic agent and one vasopressor for circulatory assistance. The groups were comparable in the etiology of heart disease, in the use of revascularization procedures, the use of balloon counterpulsation, and APACHE-II score (33 ± 5 vs. 33 ± 4) and SOFA score (11 ± 1 vs. 11 ± 1) at inclusion; however, more patients in SC were subject to resuscitation before inclusion. Hospital-acquired pneumonia occurred in 10 patients in KT and 28 patients in SC (p < 0.001); pressure ulcers were seen in 10 versus 2 patients (p < 0.001). Hospital mortality tended to be lower in KT, and 1-year all-cause mortality was 41 % in KT and 66 % in SC (p = 0.028).
The use of KT reduces rates of pneumonia and pressure ulcers as compared to SC. Moreover, in this study, patients with KT had a better outcome. The study suggests that KT should be used in patients with cardiogenic shock requiring ventilator therapy for a prolonged time.
连续横向旋转治疗（KT）已被证明可减少创伤患者的并发症并缩短住院时间。但在非手术患者中的数据尚无定论。回顾性数据表明，KT 对需要呼吸机治疗的心源性休克（CS）患者有益。然而，KT 尚未在这些患者中进行前瞻性测试。
进行了一项前瞻性、随机、开放标签试验，比较了使用振荡床（TryaDyne Proventa，KCI）的 KT 与标准护理（SC）。纳入需要呼吸机治疗超过 24 小时的心源性休克患者。主要终点是医院获得性肺炎的发生。次要终点是住院期间压疮的发生和 1 年全因死亡率。
45 例患者随机分为 KT 组，44 例患者分为 SC 组。所有患者均需要至少一种正性肌力药物和一种血管加压药来进行循环辅助。两组在心脏病病因、再血管化手术的使用、气囊反搏的使用以及 APACHE-II 评分（33 ± 5 与 33 ± 4）和 SOFA 评分（11 ± 1 与 11 ± 1）方面相似；然而，SC 组中有更多的患者在纳入前需要复苏。KT 组有 10 例患者发生医院获得性肺炎，SC 组有 28 例（p < 0.001）；KT 组有 10 例患者发生压疮，SC 组有 2 例（p < 0.001）。KT 组的住院死亡率较低，1 年全因死亡率为 41%，SC 组为 66%（p = 0.028）。
与 SC 相比，KT 可降低肺炎和压疮的发生率。此外，在这项研究中，KT 组患者的预后更好。研究表明，KT 应在需要长时间呼吸机治疗的心源性休克患者中使用。
