Effect of a Rotating Bed on the Incidence of Pulmonary Complications in Critically Ill Patients

Gentilello, Lawrence; Thompson, David A.; Tonnesen, Alan S.; Hernandez, Deedee; Kapadia, Asha S.; Allen, Steven J.; Houtchens, Bruce A.; Miner, Michael E.

doi:10.1097/00003246-198808000-00010

Cited by 158 publications

(60 citation statements)

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“…Nonetheless, a recent survey by the University Hospital Consortium revealed that compliance with the simple and no-cost intervention of elevating the head is woefully low, and a study by Heyland et al revealed that the head of bed is on average elevated to 29°and not 45° (80). Kinetic bed therapy has also led to a reduction in the incidence of VAP (46,48,69,72,97,202,213). However, this is costly and has not been directly compared to head-of-bed elevation, a nocost option.…”

Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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SUMMARY While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.

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Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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“…[1][2][3][4] Reports have described the use of CLRT to decrease the duration of mechanical ventilation and the incidence of lower respiratory tract infection and increase the length of time before the development of respiratory tract infection and pneumonia. [1][2][3][4] Hepatopulmonary syndrome (HPS) is a known sequela of liver failure that is characterized by liver disease, pulmonary vascular dilation, and abnormal arterial oxygenation, which can result in severe hypoxemia. 5 It was previously considered to be a relative contraindication to orthotopic liver transplantation (OLT) because of the increased risk for mortality, both in the perioperative and postoperative periods.…”

confidence: 99%

Trendelenburg positioning and continuous lateral rotation improve oxygenation in hepatopulmonary syndrome after liver transplantation

et al. 1998

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Hepatopulmonary syndrome (HPS) is characterized by hypoxia, orthodeoxia, and platypnea, associated with severe chronic liver disease. Liver transplantation is generally viewed as the only curative treatment for this syndrome, but it may be complicated by prolonged hypoxia after the procedure. We report on a 58-year-old female patient with alcoholic cirrhosis and HPS who underwent liver transplantation. She developed severe hypoxia after transplantation that improved with the initiation of Trendelenburg's positioning in combination with continuous lateral rotation. Although many techniques for dealing with posttransplant hypoxia for HPS have been described, positioning is a simple maneuver that may correct the pathophysiologic abnormalities seen in HPS by gravitationally shifting blood away from the lung bases to improve oxygenation. Although this represents a single patient, the results were reproducible, and the intervention is simple and associated with minimal potential complications. The authors think this is a useful intervention to apply to the severely hypoxic patient with HPS, and a trial with more patients is warranted. Copyright 1998 by the American Association for the Study of Liver DiseasesT he ability of continuous lateral rotation therapy (CLRT) to help manage pulmonary complications in the intensive care unit setting has been well documented. [1][2][3][4] Reports have described the use of CLRT to decrease the duration of mechanical ventilation and the incidence of lower respiratory tract infection and increase the length of time before the development of respiratory tract infection and pneumonia. [1][2][3][4] Hepatopulmonary syndrome (HPS) is a known sequela of liver failure that is characterized by liver disease, pulmonary vascular dilation, and abnormal arterial oxygenation, which can result in severe hypoxemia. 5 It was previously considered to be a relative contraindication to orthotopic liver transplantation (OLT) because of the increased risk for mortality, both in the perioperative and postoperative periods. [6][7][8] However, more recent data have been supportive of OLT as treatment for HPS, even in the severely hypoxic patient. 6,9 Case studies have shown that HPS can be reversible after successful transplantation in up to 84% of the patients; the main cause of death is refractory hypoxemia and/or multisystem failure secondary to hypoxia. 6,10 Both survivors and nonsurvivors may need weeks and sometimes months of supportive treatment for prolonged hypoxemia, because not all patients recover from HPS in the immediate postoperative period. We report the use of Trendelenburg' s positioning combined with CLRT to improve and maintain oxygenation in a patient with HPS who underwent OLT. Case ReportA 58-year-old woman with end-stage liver disease secondary to alcoholic cirrhosis underwent OLT at St Francis Medical Center, a 220-bed acute care and transplant center in Honolulu, Hawaii. Before the procedure, she was given a diagnosis of type I HPS based on clinical findings and pulmonary arteriogr...

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“…Passive and active-assisted mobilisation [15,[23][24][25][26][27][28][29] Continuous rotational therapy [30][31][32] Postures [18,[33][34][35][36][37][38][39][40] Active limb exercise [41][42][43] Peripheral muscle training [44,45] Neuromuscular electrical stimulation [46][47][48][49][50][51][52][53][54][55] Respiratory muscle training [56][57][58][59][60] Airway secretions…”

Section: Muscle Weaknessmentioning

confidence: 99%

Rehabilitation, weaning and physical therapy strategies in chronic critically ill patients

Ambrosino

Venturelli²,

Vagheggini³

et al. 2011

Eur Respir J

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In critically ill patients, a prolonged hospital stay, due to the initial acute insult and adverse side-effects of drug therapy, may cause severe late complications, such as muscle weakness, prolonged symptoms, mood alterations and poor health-related quality of life.The clinical aims of physical rehabilitation in both medical and surgical intensive care units (ICUs) are focussed on the patient to improve their short-and even long-term care.The purpose of this article is to review the currently available evidence on comprehensive rehabilitation programmes in critically ill patients, and describe the key components and techniques used, particularly in specialised ICUs.Despite the literature suggesting that several techniques have led to beneficial effects and that muscle training is associated with weaning success, scientific evidence is limited. Due to limitations in undertaking comparative studies in ICUs, further studies with solid clinical shortand long-term outcome measures are now welcomed.

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Effect of a Rotating Bed on the Incidence of Pulmonary Complications in Critically Ill Patients

Cited by 158 publications

References 0 publications

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Trendelenburg positioning and continuous lateral rotation improve oxygenation in hepatopulmonary syndrome after liver transplantation

Rehabilitation, weaning and physical therapy strategies in chronic critically ill patients

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