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CONTINUOUS LATERAL ROTATION THERAPY FOR ACUTE LUNG INJURY: TIMING MATTERS

Sarasota Memorial Healthcare System, Sarasota, FL

PURPOSE: Continuous Lateral Rotation Therapy has been shown to reduce nosocomial pneumonia, intensive care unit (ICU) length of stay (LOS) and the number of ventilator days. No study has addressed the effect of this therapy specifically on the course of acute lung injury (ALI) or the effect of timing of institution of Continuous Lateral Rotation Therapy (CLRT). This study was designed to determine whether use of a CLRT protocol would decrease morbidity and mortality, ventilator days and/or ICU LOS in ALI.

METHODS: The study was conducted in a 32 bed Medical/Surgical ICU in an 828 bed community owned acute care hospital. Twenty-three patients were selected over a three month period who met the protocol criteria of mechanical ventilation, FIO2 >0.5 and PaO2/FIO2 ratios <300. A randomized retrospective control group of 23 subjects (every other patient who met study criteria) was selected from a comparable time period during the previous year. A randomized subgroup of the treatment group was selected to evaluate the impact of therapy lag time on clinical outcomes. Twenty patients who were placed on CLRT <5 days after meeting study criteria were compared to 14 patients placed on CLRT > 5 days after meeting criteria.

RESULTS: The two groups had no significant difference in age. The CLRT group had a significantly higher Acute Physiology Score (APS), and predicted mortality based on the APACHE III database although these differences were not statistically significant. Comparisons between the CLRT initiation <5 days and CLRT >5 days are contained in Table 1. Mean ventilator days and ICU LOS were significantly reduced for patients placed on CLRT earlier in their course. Standardized mortality ratio (SMR- observed/predicted mortality) was decreased but the sample size was too small to permit statistical analysis.

CONCLUSION: Earlier institution of CLRT may improve ALI outcomes. Larger trials are necessary to confirm these results.

CLINICAL IMPLICATIONS: Early institution of CLRT should be considered for all patients with ALI. Delay in initiation may increase ventilator days and ICU length of stay.

CLRT Lag time 5 days n = 14 CLRT Lag time < 5 days n = 20 p Value Acute Physioloy Score (APS) 66.98 65.17 0.233 Ventilator Days (avg) 23.43 11.5 0.008 ICU LOS (avg) 27.86 14.65 0.003 Hospital LOS (avg) 31.5 22.5 0.202 Standardized Mortality Ratio (SMR) 1.71 1.0 N/A

DISCLOSURE: Rhonda Anderson, Other Statistical support and partial analysis was provided by Hill-Rom