Background: Some critically ill patients have
difficulty in mobilizing their respiratory secretions. These patients
can develop pulmonary atelectasis that may result in hypoxemia. There
are some data to show that atelectasis may be prevented by turning a
patient from side to side utilizing special beds.
objectives: To determine the role of kinetic therapy (KT)
combined with mechanical percussion (P) in the resolution of
established atelectasis of the lungs and hypoxemia in critically ill,
hospitalized patients. (KT was defined as rotation of a patient along
the longitudinal axis of ≥ 40° to each side continuously.)
Design: Prospective and randomized study (2:1 test to
Patients: Twenty-four patients with
respiratory failure, either mechanically ventilated or spontaneously
breathing, who demonstrated segmental, lobar, or unilateral entire lung
atelectasis were studied.
Setting: Medical ICU and
adult respiratory ward in a county hospital in New York.
Interventions: Seventeen patients were treated with KT
combined with mechanical P using a KT system (Triadyne Kinetic Therapy
System; KCI; San Antonio, TX). Seven patients received manual
repositioning and manual P every 2 h. Both groups received similar
conventional therapy with inhaled bronchodilators and suctioning.
Results: Partial or complete resolution of atelectasis was
seen in 14 of 17 patients (82.3%) in the test group as compared with 1
of 7 patient (14.3%) in the control group. The median duration to
resolution of atelectasis was 4 days in the test group. Bronchoscopy
was performed in 3 of 7 patients in the control group, but in none of
the patients in the test group. A cost of $720 was incurred per patient
for utilizing the specialty beds for a mean duration of 4 days. An
improvement in oxygenation index occurred in the test group (change in
baseline Pao2/fraction of inspired oxygen from
207.4 ± 106.7 mm Hg to 318 ± 100.7 mm Hg) at the end of therapy,
while the control group showed a reduction over a similar duration of
time (181.3 ± 96.3 mm Hg to 112 ± 21.2 mm Hg).
Conclusions: KT and mechanical P therapy resulted in
significantly greater partial or complete resolution of atelectasis as
compared with conventional therapy. There was a generalized trend
toward statistical significance in the improvement of oxygenation and a
reduced need for bronchoscopy in the group receiving KT and P