PURPOSE: To examine the efficacy of a pulmonary therapy bed system that provides continuous lateral rotation therapy (CLRT) through oscillation, in reducing ventilator weaning time, time to extubation, and Medical Intensive Care Unit (MICU) length of stay.
METHODS: All MICU intubated patients meeting inclusion criteria were randomized into one of two groups: Group 1) Standard/Usual Care which included elevating the head of the bed a minimum of 30 degrees, turning, suctioning, and initiating bronchopulmonary hygiene (BPH) orders; or Group 2) CLRT with the standard/usual care plus rotating the bed at least 18 hours in a 24 hour period. The main study outcome measures were time to successful extubation (extubation occurring without reintubation within 48 hours) and MICU LOS. Subjects were followed until extubation or 28 days.
RESULTS: 42 patients were assigned to the standard group and 44 patients were assigned to the CLRT group. The groups were similar in age (62 + 15 years), APACHE II (18 + 5.6), and primary diagnosis (Respiratory Failure). A greater proportion of the CLRT group were extubated within 28 days (p=0.40): CLRT n= 27 (61%) vs. Standard Care n=22 (52%). Median time to extubation did not differ (p=0.56): CLRT 119.2 hours vs. Standard Care 88.5 hours. Median MICU LOS did not differ (p=0.99): CLRT 139.2 hours vs. Standard Care 172.8 hours.
CONCLUSION: Although statistical significance was not observed, the data does have clinical relevance. A higher proportion of patients receiving CLRT were successfully extubated. This may be a factor in achieving earlier MICU discharge than patients receiving standard care with a nine percent difference in successful extubation and earlier MICU discharge of 33.6 hours.
CLINICAL IMPLICATIONS: Many challenges exist to delivering adequate BPH, including personnel shortages and increasing workload. The incorporation of technologies that can assist in delivering BPH may result in a higher percentage of patients receiving BPH without burdening personnel and may contribute to a reduction in MICU length of stay.
DISCLOSURE: Nina Fielden, No Product/Research Disclosure Information; Grant monies (from industry related sources) Hill-Rom provided monies to conduct the research. They also provided the Total Care Sport Beds to use in the studies.