Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients

Abstract

BACKGROUND: When liver transplant candidates and recipients suffer from pulmonary complications of immobility, the results can be life-threatening. Continuous lateral rotation therapy has been reported to decrease complications of immobility. OBJECTIVES: To determine whether continuous lateral rotation therapy decreases the duration of mechanical ventilation, intensive care unit length of stay, incidence or resolution of atelectasis, incidence or onset time of lower respiratory tract infection and pneumonia. METHODS: Sixty-nine subjects admitted to a liver transplant intensive care unit at a university teaching hospital were randomly assigned to continuous lateral rotation therapy or a stationary bed. All subjects were mechanically ventilated for 24 hours and had a Glasgow Coma Scale score of 11 or less upon admission to the study. Subjects were followed until out of bed, unable to rotate for 3 consecutive days, or transferred from the intensive care unit. Data and chest roentgenogram results were collected on admission and daily during the study. Sputum culture results were obtained if available as part of normal patient care. RESULTS: Incidence of lower respiratory tract infection was significantly lower and length of time to occurrence of lower respiratory tract infection was significantly longer in the continuous lateral rotation therapy group than in the stationary bed group. CONCLUSIONS: Although continuous lateral rotation therapy did not affect duration of mechanical ventilation, length of stay, or incidence of atelectasis, it was effective in decreasing the incidence of, and increasing onset time to, lower respiratory tract infection in the liver transplantation population.

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

“…[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.…”

Continuous lateral rotation therapy – a review

“…Data from these studies support the use of CLRT in critically ill patients, although it should be noted that manufacturer involvement may have introduced bias into the study. Whiteman et al (1995) found that the increased cost of CLRT is offset by reduced nosocomial pneumonia and antibiotic use and a decreased length of stay in the hospital and the ICU. Sahn (1991) reviewed the results of four prospective randomized studies (36-39) and two retrospective analyses.…”

Terapia rotacional: eixo longitudinal, em unidade de terapia intensiva

“…Alguns estudos relataram benefícios da TR para diferentes condições em pacientes hospitalizados: com disfunções pulmonares 17,18 , com lesão cerebral 19 , com lesão medular 20,21 , com transplante hepático 22 , com acidente vascular cerebral 23,24 , entre outros. No entanto, esse recurso ainda é pouco difundido entre os profissionais de saúde e hospitais, não sendo utilizado rotineiramente.…”