Critical Care Beds With Continuous Lateral Rotation Therapy to Prevent Ventilator-Associated Pneumonia and Hospital-Acquired Pressure Injury: A Cost-effectiveness Analysis

Abstract

Objectives Mechanical ventilation increases the risk of hospital-acquired conditions (HACs) such as ventilator-associated pneumonia (VAP) and pressure injury (PrI). Beds with continuous lateral rotation therapy (CLRT) are shown to reduce HAC incidence, but the value of switching to CLRT beds is presently unknown. We compared the cost-effectiveness of CLRT beds with standard care in intensive care units. Methods A cost-effectiveness analysis from the healthcare sector and societal perspectives was conducted. A Markov model was constructed to predict health state transitions from time of ventilation through 28 days for the healthcare sector perspective and 1 year for the U.S. societal perspective. Value of information was calculated to determine whether parameter uncertainty warranted further research. Results Our analysis suggested that CLRT beds dominate standard care from both perspectives. From the healthcare sector perspective, expected cost for CLRT was U.S. $47,165/patient compared with a higher cost of U.S. $49,258/patient for standard care. The expected effectiveness of CLRT is 0.0418 quality-adjusted life years/patient compared with 0.0416 quality-adjusted life years/patient for standard care. Continuous lateral rotation therapy dominated standard care in approximately 93% of Monte Carlo simulations from both perspectives. Value of information analysis suggests that additional research is potentially cost-effective. Conclusions Continuous lateral rotation therapy is highly cost-effective compared with standard care by preventing HACs that seriously harm patients in the intensive care unit.

Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database

“…The prevention of HAPIs involves frequent patient turning and repositioning, use of heel protectors or suspension devices, use of prophylactic foam dressings on high‐risk skin areas and appropriate bed support surfaces, as well as multidisciplinary team approaches, 1,2,6,8,11,15‐17 and these strategies can be adapted to the care setting 1 . However, despite efforts to prevent HAPIs, national rates continue to increase.…”

Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review

“…A randomized trial showed reduced VAP incidence using a special bed able to rotate a patient's thorax laterally, continuously alternating the rotation side; the measure appeared to be cost-effective in a recently published analysis. 91,92 Alternative positions such as the lateral-Trendelenburg position were proposed to prevent VAP because when the head of the patient is lower than the airways, vomiting does not result in the leak of gastric material within the airways and tracheal secretion clearance is improved. A randomized clinical trial 93 showed a reduced VAP rate in the lateral-Trendelenburg group; however, the trial was prematurely stopped due to lower overall VAP incidence and increase of adverse events in the treatment group.…”