Continuous Lateral Rotation Therapy

Abstract

Pulmonary complications remain common in critically ill patients and are especially prevalent in patients who are intubated and receiving mechanical ventilation. These complications include hypoxia, atelectasis, and hospital-acquired infections. The Institute for Healthcare Improvement has reported that ventilator-associated pneumonia is one of the most frequent causes of increased hospital morbidity and mortality. To prevent these complications of therapy, nurses have traditionally turned patients from side to side every 2 hours. However, this type of manual turning has not been reported to have a significant effect on pulmonary function. Continuous lateral rotation therapy (CLRT), an integral part of progressive mobility, came into use in the 1970s in an effort to reduce pulmonary complications of immobility. Lateral rotation therapies were delivered via continuous-motion bed frames that rotated the patient from side to side. Known by many different names, lateral rotation has been most commonly referred to as CLRT or kinetic therapy. Over the years, numerous studies have been performed to examine the effectiveness of CLRT. Many studies have shown improvement in various pulmonary outcome indicators when lateral rotation therapies were implemented. Mobilization of patients is widely accepted to reduce the impact of prolonged bed rest. However, during critical phases of acute illness, early mobilization of patients is difficult to accomplish. Therefore, the introduction of CLRT into patient care can provide an efficient way of providing early mobility to those critically ill patients whose condition or instability prevents implementation of other forms of mobility. Identification of patient populations who will benefit from CLRT is an important aspect of maximizing the benefits of therapy. McKay suggested that CLRTs achieve the best outcomes when implemented within 24 to 48 hours of meeting set criteria and are maintained for at least 18 hours per day. SwadenerCulpepper et al reported that CLRT patients in an early intervention group (implemented within 48 hours of meeting criteria) fared much better on the outcome criteria evaluated than did the late intervention group (CLRT implemented more than 48 hours after criteria were met). Therefore, early identification of patients who could benefit from therapy has the best potential for improving outcomes. Many criteria have been suggested in the identification of pulmonary patients who could benefit from CLRT. Methods that are quick and simply evaluated are most easily implemented in a busy critical care environment. One such method is the calculation of the PaO2/FIO2 ratio (P/F ratio). The P/F ratio reflects the effectiveness of oxygen transfer from the lung to hemoglobin. P/F ratios greater than 300 are considered to indicate minor pulmonary insufficiency, but ratios less than 300 are considered to indicate acute lung injury. Lower P/F ratios would indicate worsening of pulmonary function compared with higher ratios. Setting CLRT criteria at a P/F ratio of 300