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Continuous lateral rotational therapy in thoracic trauma--A matched pair analysis.
Mark Schieren1, Frank Wappler1, Daniel Klodt2
1University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
Injury
|November 24, 2019
Summary
Continuous lateral rotational therapy (CLRT) showed no significant benefit for patients with chest trauma, despite its use in ICUs. Further research is needed to confirm these findings in larger studies.
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Respiratory Therapy
Background:
- Evidence on the effectiveness of continuous lateral rotational therapy (CLRT) for chest trauma patients is limited.
- A retrospective matched-pair analysis was conducted to evaluate CLRT versus manual turning in blunt thoracic trauma.
- The study aimed to assess the impact of CLRT on patient outcomes and respiratory complications.
Purpose of the Study:
- To determine if continuous lateral rotational therapy (CLRT) offers clinical benefits for patients with severe thoracic injuries requiring mechanical ventilation.
- To compare outcomes between patients treated with CLRT and those receiving standard manual turning.
- To investigate the effect of CLRT on respiratory function, ventilation duration, and patient outcomes.
Main Methods:
- A retrospective matched-pair analysis of 22 pairs (44 patients) admitted to a level 1 trauma center (2010-2014).
- Inclusion criteria: severe thoracic injuries (AISThorax ≥3), mechanical ventilation ≥72 hours.
- Matching criteria: thoracic injury severity, age, additional injuries, and massive transfusion requirements.
Main Results:
- CLRT did not significantly improve respiratory function, gas exchange, or reduce mechanical ventilation duration, ICU/hospital stay, or mortality.
- Sedation levels were lower during CLRT compared to manual turning (p=0.01).
- Patient agitation was more frequent in the CLRT group (41%) versus manual turning (9%) (p=0.02).
Conclusions:
- In this matched sample, CLRT provided no significant clinical benefits for thoracic trauma patients under modern ICU care with lung-protective ventilation.
- Limitations include small sample size and single-center design, restricting statistical power and generalizability.
- A large randomized controlled trial (RCT) is necessary to provide definitive conclusions on CLRT's efficacy in chest trauma.
