Continuous lateral rotational therapy in the medical intensive care unit

The efficacy of continuous lateral rotational therapy (CLRT) for mechanically ventilated patients is not well established. This study investigated the effect of CLRT on gas exchange and the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients in a medical intensive care unit (ICU).

Thirty five mechanically ventilated patients in a medical ICU received CLRT for 5 days, while 35 control patients matched for age, gender, cause of respiratory failure, and admission Acute Physiology and Chronic Health Evaluation (APACHE) score, received routine positional change. The results of blood gas analysis, incidence of VAP, findings on chest radiograph, length of ICU stay, and sputum characteristics were recorded.

Greater improvement in oxygenation index (the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) was noted in the patients who received CLRT (31 +/- 42 vs 6 +/- 76, p = 0.03). Patients who received CLRT also had lower VAP incidence (0 vs 5, p < 0.001), were more likely to have improvement in pulmonary infiltrates (17 vs 12, p = 0.04) and had shorter ICU stay (22 +/- 8 days vs 27 +/- 12 days, p = 0.09). The ICU discharge status (dead, ventilator dependent, alive) was not significantly different between the 2 groups.

Mechanically ventilated patients in the medical ICU who received CLRT had improved oxygenation and reduced incidence of VAP compared to controls.