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Continuous lateral rotation therapy to prevent ventilator-associated pneumonia*

Staudinger, Thomas MD; Bojic, Andja MD; Holzinger, Ulrike MD; Meyer, Brigitte MD; Rohwer, Marion MD; Mallner, Friederike MD; Schellongowski, Peter MD; Robak, Oliver MD; Laczika, Klaus MD; Frass, Michael MD; Locker, Gottfried J. MD

doi: 10.1097/CCM.0b013e3181bc8218
Clinical Investigations

Objective: To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients.

Design: Prospective, randomized, clinical study.

Setting: Three medical intensive care units of an university tertiary care hospital.

Patients: Patients were randomized to continuous lateral rotation therapy or standard care if they were mechanically ventilated for <48 hrs and free from pneumonia. Primary study end point was development of ventilator-associated pneumonia. Ventilator-associated pneumonia was defined as infiltrate on the chest radiograph plus newly developed purulent tracheal secretion plus increasing signs of inflammation. The diagnosis had to be confirmed microbiologically and required the growth of a pathogen >104 colony-forming units/mL in bronchoalveolar lavage. Radiologists were blinded to randomization whereas clinical outcome assessors were not.

Interventions: Rotation therapy was performed continuously in a specially designed bed over an arc of 90°. Additional measures to prevent ventilator-associated pneumonia were equally standardized in both groups including semirecumbent position.

Measurements and Main Results: Ventilator-associated pneumonia frequency during the intensive care unit stay was 11% in the rotation group and 23% in the control group (p = .048), respectively. Duration of ventilation (8 ± 5 vs. 14 ± 23 days, p = .02) and length of stay (25 ± 22 days vs. 39 ± 45 days, p = .01) were significantly shorter in the rotation group. In a forward stepwise logistic regression model including the continuous lateral rotation therapy, gender, Lung Injury Score, and Simplified Acute Physiology Score II, continuous lateral rotation therapy just failed to reach statistical significance with respect to development of ventilator-associated pneumonia (p = .08). Intolerance to continuous lateral rotation therapy during the weaning phase was observed in 29 patients (39%). Mortality was comparable in both groups.

Conclusions: Ventilator-associated pneumonia prevalence was significantly reduced by continuous lateral rotation therapy. Continuous lateral rotation therapy led to shorter ventilation time and length of stay. Continuous lateral rotation therapy should be considered in ventilated patients at risk for ventilator-associated pneumonia as a feasible method exerting additive effects to other preventive measures.

From the Department of Internal Medicine I (TS, AB, MR, FM, PS, OR, KL, MF, GJL), Intensive Care Unit; Department of Internal Medicine III (UH), Division of Gastroenterology, Intensive Care Unit; Department of Internal Medicine II (BM), Division of Cardiology, Intensive Care Unit, Medical University of Vienna, Vienna, Austria.

The study was funded, in part, by the Medical University of Vienna.

Dr. Staudinger has received honoraria from KCI and has also served on their Advisory Board for the last 3 yrs. The remaining authors have not disclosed any potential conflicts of interest.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ccmjournal.com).

For information regarding this article, E-mail: thomas.staudinger@meduniwien.ac.at

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins