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The Impact of Continuous Lateral Rotation Therapy in Overall Clinical and Financial Outcomes of Critically Ill Patients

Swadener-Culpepper, Leslie MSN, RN, CCRN, CCNS; Skaggs, Rita L. RN; VanGilder, Catherine A. BS, MT, CCRA

doi: 10.1097/01.CNQ.0000325051.91473.42
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Background Significant pulmonary complications are prevalent in intubated and mechanically ventilated patients.

Objectives This study was conducted to determine the impact of continuous lateral rotation therapy (CLRT) on patients considered to be at high risk for pulmonary complications. Overall study objectives included hospital length of stay, critical care length of stay, ventilator days, and cost to treat.

Methods Patients at risk for pulmonary complications as defined by Pao2/Fio2 ratio < 300, Fio2 > 50% for more than 1 hour, positive end-expiratory pressure ≥ 8, or a Predicus score of ≥ 5 were compared with a historical comparison group that met the high-risk criteria given above and did not receive CLRT. Patients who received CLRT were separated into 2 groups, early CLRT group (began therapy within 48 hours, n = 49) or late CLRT group (n = 46).

Results The early CLRT group had a reduction in critical care LOS, (P = .04) as compared with the non-CLRT group. Total hospital costs were reduced (P = .01) in the early intervention group compared to the late intervention group, as well as ICU LOS (P = .02). Nonsignificant trends were seen in reduced ventilator days and hospital LOS. Reintubation rates and readmissions to critical care were also lower in the early intervention group.

Conclusions Continuous lateral rotation therapy, when introduced early in course of treatment of high-risk patients, reduces critical care LOS and cost to treat.

Critical Care Clinical Nurse Specialist, The Medical Center of Central Georgia (Ms. Swandener-Culpepper). APACHE Coordinator, The Medical Center of Central Georgia (Ms Skaggs); and Clinical Research, Hill-Rom, Batesville, IN (Ms VanGilder).

Corresponding Author: Leslie Swadener-Culpepper, MSN, RN, CCRN, CCNS, 777 Hemlock St, Hospital Box 19, Macon, GA 31201 (culpepper.leslie@mccg.org).

Funding sources for the study were provided by Hill-Rom, Batesville, Indiana. They contributed to the design of the study and provided travel and ancillary support for this project.

© 2008 Lippincott Williams & Wilkins, Inc.