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RES224
Clinical Outcomes and Satisfaction with Continuous Lateral Rotation Therapy (CLRT) in a Medical Intensive Care Unit
By: N. M.Fielden, & L. J.Lewicki; Cleveland Clinic, Cleveland, OH
For further information, please contact: fielden@ccf.org
Purpose: The purpose of the study was to compare the effect of the TotalCare® SpO2RT® Pulmonary Therapy System (mechanical therapy) to Medical Intensive Care Unit (MICU) standard pulmonary therapy (manual method) on clinical outcomes, patient acceptance and tolerance to rotation, and clinician satisfaction.
Background/Significance: Despite CLRT being an available critical care therapy, the literature has presented mixed results related to its efficacy. Criticism of research has been small sample sizes and a lack of definition of rotation. Additionally, the issue of patient tolerance and acceptance appears to have limited use which may have impacted effectiveness. This research attempted to fill the void by ensuring an adequate sample size and including efficacy measures as well as patient and clinicians’ satisfaction.
Methods: All intubated, weanable MICU patients were randomized into two groups: Hill-Rom® Zone Aire® bed receiving standard/usual care (bronchopulmonary hygiene, turning q2hours) or the Hill-Rom® TotalCare® SpO2RT® Pulmonary Therapy System with CLRT. The primary outcome measures were time to extubation and MICU length of stay. Secondary outcomes included the incidence of nosocomial pressure ulcers and urinary tract infections (UTIs). Patient, Nurse (RN) and Respiratory Therapist (RRT) satisfaction with CLRT and standard therapy was measured using a Likert scale. The RN and RRT satisfaction also assessed the presence of back/shoulder pain after using both therapies.
Results: Patients were assigned to standard care (41) or CLRT (45). The 2 groups were similar; age (62 + 15 years), APACHE II (18 + 5.6), primary diagnosis (Respiratory Failure) and indication for intubation (Airway Protection). Median time to extubation (CLRT 119.2 vs. Standard 88.5, hours; p = 0.56), and median MICU stay (CLRT 139.2 vs. Standard 172.8, hours; p = 0.99) did not differ. Standard care had an increased incidence of pressure ulcers (p=.01) and UTIs (p=.05). Patient satisfaction was similar except for comfort level; higher for CRLT (p=.05). RNs and RRTs were satisfied with CLRT functions/results and experienced no, or lower levels of back pain compared to standard care(p=.05).
Conclusions: CLRT was an accepted therapy by patients, RNs and RRTs. However, not all available CLRT functions were used according to protocol suggesting re-education may be needed. MICU discharge may be facilitated with CLRT, as a greater proportion were extubated within 28 days (p=0.40).
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