Kinetische Therapie zur Therapie und Prophylaxe der posttraumatischen Lungeninsuffizienz

Abstract

The effects of kinetic therapy on the oxygenation in the injured lung of 111 polytrauma patients were analysed in an open prospective study. The patient collective comprised 82 men and 29 women. For the total group, the average age was 38.3 years (+/- 16.1). The initial ISS was 39.3 points (+/- 18.9), and the APACHE II evaluated 24 h after including the patient into the study was 13.1 (+/- 5.2). The data of 3 treatment groups were evaluated: 1, acute respiratory disease (ARDS, n = 42); 2, acute lung injury (ALI, n = 36); and 3, prophylaxis (n = 33, a group of prophylactically treated patients with a PaO2/FiO2 ratio > or = 300 and an ISS > or = 15). Positioning therapy was administered in group 3 in order to prevent atelectases, and respirator-induced lung injuries during a foreseeable, relatively long period in the intensive care unit in view of the severity of the trauma. The mean treatment time in the kinetic bed was 6.3 days (+/- 3.9), the time on respirator 18.5 days (+/- 15.4). The patients stayed in the ICU 22.4 days (+/- 15.4) and left the hospital after 35.1 days (+/- 27.7). For scoring the severity of respiratory failure, the lung injury score (LIS) according to Murray and the SOFA score lung (sepsis-related organ failure assessment) according to Vincent were evaluated. The LIS at time of recruitment into the study was 2.2 (+/- 1.0), the SOFA score lung 3.0 (+/- 0.9). In the ALI and ARDS groups a significant improvement in oxygenation was observed (p < 0.0001). No patient of the prophylaxis group developed an ALI or ARDS. The mortality rate in the total group of 10.8% was relatively low in comparison with other published data. Consistent kinetic therapy integrated in a standardised treatment regimen contributes towards improving the negative outcome to date of patients with severe respiratory failure after major trauma.

S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders

“…CLRT improves the pulmonary gas exchange in patients with acute respiratory insufficiency (evidence level 2b) [ 25 , 222 , 223 , 237 , 238 , 265 , 267 ]. The following effects were confirmed starting at a rotational angle of ≥ 40° on each side:…”

Kinetic Therapy Reduces Complications and Shortens Hospital Stay in Patients with Cardiogenic Shock — A Retrospective Analysis

“…Initially invented to prevent pressure ulcers, it rapidly became obvious that KT improves pulmonary conditions in critically ill patients. A couple of smaller studies have demonstrated beneficial effect of KT in patients with major trauma [4][5][6][7]. Recently, these results have been confirmed in a larger, prospective, randomized trial, in which KT was highly effective to prevent pulmonary complications in critically ill trauma patients [8].…”

“…2. Ventilator use has been reduced by a median [25th, 75th percentile] of 7 days (KT, 11 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23], SC 18 [9-23] days). In consequence, ICU stay was reduced by a median of 8 days, and the time to discharge or referral was reduced by a median of 5 days.…”