Efficacy of Continuous Lateral Rotation Therapy in Mechanically Ventilated Critically Ill Adults on Clinical Outcomes

Anna Luísa A Brito; Amanda Caroline de A Ferreira; Layane Santana P Costa; Emanuel Fernandes F da S Júnior; Shirley Lima Campos

doi:10.4187/respcare.11781

Efficacy of Continuous Lateral Rotation Therapy in Mechanically Ventilated Critically Ill Adults on Clinical Outcomes

Respir Care. 2024 May 14:respcare.11781. doi: 10.4187/respcare.11781. Online ahead of print.

Authors

Anna Luísa A Brito¹, Amanda Caroline de A Ferreira¹, Layane Santana P Costa¹, Emanuel Fernandes F da S Júnior², Shirley Lima Campos¹

Affiliations

¹ Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco (UFPE), Recife, Pernambuco, 50740-560, Brazil.
² Health-applied Biology Graduate Program, Federal University of Pernambuco (UFPE), Recife, Pernambuco, 50740-560, Brazil.

PMID: 38744476
DOI: 10.4187/respcare.11781

Abstract

Background: This PICO-guided systematic review assessed continuous lateral rotation therapy (CLRT) versus conventional position changes in mechanically ventilated critically ill adults, evaluating mortality, intensive care unit (ICU) and hospital stay duration as primary outcomes, and respiratory function, mechanical ventilation duration, pulmonary complications, and adverse events, as secondary outcomes. Methods: A systematic review followed PRISMA criteria (PROSPERO CRD42022384258). Searches spanned databases: MEDLINE/PubMed, EMBASE, Scopus, ScienceDirect, Cochrane, CINAHL and Web of Science, without language or publication year restrictions. Inclusion criteria involved randomized (RCT) and quasi-randomized trials, comparing CLRT (intervention) with conventional position changes (control). Risk of bias and quality of evidence for RCTs were assessed using the Cochrane collaboration and GRADE tools. For the quasi-randomized trials, the ROBINS-I tool was used. Results: In 18 studies with 1.466 participants (intervention, n= 700, 47.7%; control, n= 766, 52.2%), CLRT was predominantly used for prophylactic purposes, with protocols varying from 10 to 24 hours/day. Meta-analysis (16 RCTs) favored CLRT for reduced mechanical ventilation duration (SMD -0.17 days, CI -0.29 to -0.04, p=0.008) and lower nosocomial pneumonia incidence (OR 0.39, CI 0.29 to 0.52, p<0.00001). CLRT showed no significant impact on mortality (OR 1.04, CI 0.80 to 1.34, p= 0.77), ICU stay (SMD -0.11 days, CI -0.25 to 0.02, p= 0.11), hospital stay (SMD -0.10 days, CI -0.31 to 0.11, p= 0.33) and incidence of pressure ulcers (OR 0.73, CI 0,34 to 1.60, p= 0.44). Conclusions: CLRT showed no significant difference in primary outcomes (mortality, ICU, and hospital stay duration) but revealed significant differences in secondary outcomes (consistently reduced nosocomial pneumonia, with a minor effect on MV duration), supported by moderate certainty. Very low certainty for other outcomes highlights the need for current studies in diverse clinical settings and protocols to assess CLRT effectiveness.

Keywords: Beds; Critical Care; Intensive Care Units; Mechanical; Patient Positioning; Respiratory Therapy; Ventilators.

Publication types

Review