Continuous Lateral Rotation Therapy in the Prevention of Ventilator Associated Pneumonia: A Meta-Analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XUXuchun ¹ , ZHANG Zhongheng. ²

Emergency Department of Jinhua Central Hospital. Jinhua,Zhejiang, 321000, ChinaCorresponding Author: ZHANG Zhong-heng, E-mail: zh_zhang1984@ hotmail. com;

Corresponding author：

Keywords：

Continuous lateral rotation therapy; Ventilator associated pneumonia; Meta-analysis

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the efficacy of continuous lateral rotation therapy ( CLRT) for the prevention of ventilator associated pneumonia ( VAP) . Methods Database of Medline and SinoMed were searched. Randomized and controlled trials assessing the efficacy of CLRT vs. placebo or conventional treatment for the prevention of VAP were included. Data were extracted on study population, exclusion and inclusion criteria, diagnostic criteria of VAP, incidence of VAP, ICU mortality, ICU length of stay, and
duration of mechanical ventilation. The VAP incidence and mortality were extracted as dichotomous variables and the other parameters were extracted as continuous variables. The pooled analyses of VAP incidence and mortality were performed by using Review Manager 5. 0 software. The heterogeneity was analyzed by the
statistic I2 . Results A total of 5 clinical trials met the inclusion criteria. CLRT could reduce the incidence of VAP ( OR=0. 50,95% CI 0. 32-0. 78) , and the heterogeneity was not statistically significant. The impact of CLRT on the ICU mortality was insignificant. The ICU length of stay and duration of mechanical ventilation
were not significantly different between CLRT and control groups. Conclusion CLRT is beneficial for the prevention of VAP, whereas its impacts on other clinical outcomes such as the ICU mortality, ICU length of stay, and duration of mechanical ventilation require further investigations.

Citation： XUXuchun,ZHANG Zhongheng.. Continuous Lateral Rotation Therapy in the Prevention of Ventilator Associated Pneumonia: A Meta-Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(6): 570-574. doi: Copy

1.	Kohlenberg A, Schwab F, Behnke M, et al. Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med, 2010, 36: 971-978 .
2.	National Nosocomial Infections Surveillance ( NNIS ) . System Report, data summary from January 1992 through June 2004 , issued October 2004. Am J Infect Control, 2004, 32: 470 -485.
3.	Davis K Jr, Johannigman JA, Campbell RS, et al. The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. Crit Care, 2001, 5 : 81-87.
4.	Bein TH, Reber A, Ploner F, et al. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care,2000, 11: 307-310 .
5.	Raoof S, Chowdhrey N, Raoof S, et al. Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest, 1999, 115 : 1658-1666.
6.	Olivo SA, Macedo LG, Gadotti IC, et al. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther,2008, 88: 156-175 .
7.	Traver GA, Tyler ML, Hudson LD, et al. Continuous oscillation:outcome in critically ill patients. J Crit Care, 1995, 10: 97-103.
8.	Whiteman K, Nachtmann L, Kramer D, et al. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care, 1995, 4: 133-139.
9.	MacIntyre NR, Helms M, Wuoderink R, et al. Automated rotational therapy for the prevention of respiratory complications during mechanical ventilation. Respir Care, 1999, 44: 1447-1451.
10.	Kirschenbaum L, Azzi E, Sfeir T, et al. Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-termventilatory care. Crit Care Med, 2002, 30: 1983-1986.
11.	Wang JY, Chuang PY, Lin CJ, et al. Continuous lateral rotational therapy in the medical intensive care unit. J Formos Med Assoc,2003, 102 : 788-792.
12.	Ahrens T, Kollef M, Stewart J, et al. Effect of kinetic therapy on pulmonary complications. Am J Crit Care, 2004, 13 : 376-383.
13.	Staudinger T, Bojic A, Holzinger U, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia. Crit Care Med,2010, 38: 486-490.
14.	张兵, 信如梅, 钟秀玲. 体位对呼吸机相关性肺炎的影响. 现代护理, 2006 , 12: 1402-1403.
15.	梅小丽, 喻文亮. 呼吸机相关性肺炎防治循证医学指南. 实用儿科临床杂志, 2008 , 23: 479-480.
16.	Chandy D, Sahityani R, Aronow WS, et al. Impact of kinetic beds on the incidence of atelectasis in mechanically ventilated patients. AmJ Ther, 2007, 14: 259-261 .
17.	Berra L, Cressoni M, Li Bassi G, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia: the neglected effects of gravity on pathogenesis of ventilator-associated pneumonia. Crit Care Med, 2010 , 38: 1018-1019.
18.	Bein TH, Reber A, Ploner F, et al. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care,2000, 11: 307-310 .
19.	Chandy D, Sahityani R, Aronow WS, et al. Impact of kinetic beds on the incidence of atelectasis in mechanically ventilated patients. AmJ Ther, 2007, 14: 259-261 .
20.	Swadener-Culpepper L, Skaggs RL, VanGilder CA. The impact of continuous lateral rotation therapy in overall clinical and financial outcomes of critically ill patients. Crit Care Nurs Q,2008,31: 270-279.

1. Kohlenberg A, Schwab F, Behnke M, et al. Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med, 2010, 36: 971-978 .
2. National Nosocomial Infections Surveillance ( NNIS ) . System Report, data summary from January 1992 through June 2004 , issued October 2004. Am J Infect Control, 2004, 32: 470 -485.
3. Davis K Jr, Johannigman JA, Campbell RS, et al. The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. Crit Care, 2001, 5 : 81-87.
4. Bein TH, Reber A, Ploner F, et al. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care,2000, 11: 307-310 .
5. Raoof S, Chowdhrey N, Raoof S, et al. Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest, 1999, 115 : 1658-1666.
6. Olivo SA, Macedo LG, Gadotti IC, et al. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther,2008, 88: 156-175 .
7. Traver GA, Tyler ML, Hudson LD, et al. Continuous oscillation:outcome in critically ill patients. J Crit Care, 1995, 10: 97-103.
8. Whiteman K, Nachtmann L, Kramer D, et al. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care, 1995, 4: 133-139.
9. MacIntyre NR, Helms M, Wuoderink R, et al. Automated rotational therapy for the prevention of respiratory complications during mechanical ventilation. Respir Care, 1999, 44: 1447-1451.
10. Kirschenbaum L, Azzi E, Sfeir T, et al. Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-termventilatory care. Crit Care Med, 2002, 30: 1983-1986.
11. Wang JY, Chuang PY, Lin CJ, et al. Continuous lateral rotational therapy in the medical intensive care unit. J Formos Med Assoc,2003, 102 : 788-792.
12. Ahrens T, Kollef M, Stewart J, et al. Effect of kinetic therapy on pulmonary complications. Am J Crit Care, 2004, 13 : 376-383.
13. Staudinger T, Bojic A, Holzinger U, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia. Crit Care Med,2010, 38: 486-490.
14. 张兵, 信如梅, 钟秀玲. 体位对呼吸机相关性肺炎的影响. 现代护理, 2006 , 12: 1402-1403.
15. 梅小丽, 喻文亮. 呼吸机相关性肺炎防治循证医学指南. 实用儿科临床杂志, 2008 , 23: 479-480.
16. Chandy D, Sahityani R, Aronow WS, et al. Impact of kinetic beds on the incidence of atelectasis in mechanically ventilated patients. AmJ Ther, 2007, 14: 259-261 .
17. Berra L, Cressoni M, Li Bassi G, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia: the neglected effects of gravity on pathogenesis of ventilator-associated pneumonia. Crit Care Med, 2010 , 38: 1018-1019.
18. Bein TH, Reber A, Ploner F, et al. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care,2000, 11: 307-310 .
19. Chandy D, Sahityani R, Aronow WS, et al. Impact of kinetic beds on the incidence of atelectasis in mechanically ventilated patients. AmJ Ther, 2007, 14: 259-261 .
20. Swadener-Culpepper L, Skaggs RL, VanGilder CA. The impact of continuous lateral rotation therapy in overall clinical and financial outcomes of critically ill patients. Crit Care Nurs Q,2008,31: 270-279.

Chinese Journal of Respiratory and Critical Care Medicine

Continuous Lateral Rotation Therapy in the Prevention of Ventilator Associated Pneumonia: A Meta-Analysis

Abstract Full text Figures/Tables Video References Cited by

Format

Content