Schieren Mark, Piekarski Florian, Dusse Fabian, Marcus Hanke, Poels Marcel, Wappler Frank, Defosse Jérôme
From the University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany.
J Trauma Acute Care Surg. 2017 Nov;83(5):926-933. doi: 10.1097/TA.0000000000001572.
The purpose of this study was to evaluate the impact of continuous lateral rotational therapy (CLRT) on respiratory complications and mortality in patients suffering from trauma.
The literature databases PubMed®/Medline® and the Cochrane Library® were systematically searched for prospective controlled trials comparing continuous lateral rotational therapy to conventional manual positioning in trauma patients.
A total of 8 publications (n= 422 patients) with comparable age and injury severity were included in the meta-analysis. A significant reduction in the incidence of nosocomial pneumonia (OR: 0.33, [95%CI: 0.17, 0.65], p=0.001) was observed in patients treated prophylactically with continuous lateral rotational therapy. When used with therapeutic intention, CLRT had no impact on the incidence of pneumonia. There were no significant differences in mortality, duration of mechanical ventilation, or ICU length of stay.
Analogous to studies evaluating CLRT in medical or mixed patient collectives, CLRT reduced the rates of nosocomial pneumonia in trauma patients. This, however, had no impact on overall mortality. The level of evidence of the studies included was limited by several factors. An adequately powered, well-designed multi-centre randomised controlled trial is required, to validly assess the utility of CLRT for the prevention and treatment of pulmonary complications in patients suffering from trauma.
Systematic review and meta-analysis, level III.
本研究旨在评估持续侧方旋转治疗（CLRT）对创伤患者呼吸并发症及死亡率的影响。
系统检索文献数据库PubMed®/Medline®和Cochrane图书馆®，查找比较持续侧方旋转治疗与创伤患者传统手动体位摆放的前瞻性对照试验。
共有8篇出版物（n = 422例患者）纳入荟萃分析，这些患者年龄和损伤严重程度具有可比性。预防性接受持续侧方旋转治疗的患者，医院获得性肺炎发生率显著降低（OR：0.33，[95%CI：0.17，0.65]，p = 0.001）。当用于治疗目的时，CLRT对肺炎发生率无影响。死亡率、机械通气时间或重症监护病房住院时间无显著差异。
与评估CLRT在医疗或混合患者群体中的研究类似，CLRT降低了创伤患者医院获得性肺炎的发生率。然而，这对总体死亡率无影响。纳入研究的证据水平受到多个因素的限制。需要进行一项样本量充足、设计良好的多中心随机对照试验，以有效评估CLRT对创伤患者预防和治疗肺部并发症的效用。
系统评价和荟萃分析，III级。
