Reducing respiratory complications in ICU : continuous bed rotation vs standard turning practices

Abstract

Critically-ill patients are susceptible to respiratory complications. The most common respiratory complication in the intensive care unit (ICU) is nosocomial pneumonia or hospital-acquired pneumonia (HAP) which includes ventilator associated pneumonia (VAP). VAP involves pneumonia developed in a mechanically ventilated (MV) patient. Studies recommend that ICU nurses should practice manual turnings every two hours but due to constraints this is not always possible. Throughout the years, continuous bed rotation specifically Kinetic therapy (KT) and Continuous Lateral Rotation Therapy (CLRT) were developed. These specialised beds are utilised for critically-ill patients who are prone to respiratory complications. Consequently, the following PICO elements and research question were formulated. Patient/Problem: Mechanically ventilated adult critically-ill patients Intervention: Continuous bed rotation (CLRT and KT) Comparison: Standard turning practices Outcome: Reduced respiratory complications Among mechanically ventilated adult critically-ill patients, would continuous bed rotation be more effective than standard turning practices to reduce respiratory complications? This dissertation included English language open full-text articles from the last 15 years only. The articles were limited to MV critically-ill adult patients with respiratory complications. The articles also included patients that underwent continuous bed rotation and standard turning practices. The search strategy involved a combination of 11 keywords and alternate terms inserted in 7 selected databases which generated 34,853 articles from which 95 articles were selected based on their title, presence of abstract and elimination of duplicates. The abstracts of the 95 articles were assessed which resulted in the exclusion of 62 articles. The exclusion of the 62 articles was based on the absence of the scope, purpose, method, results, conclusions and recommendations related to the studies in the abstract. Articles were also excluded if the abstract was not clear and understandable and abstract presented a poor study methodology. The remaining 33 articles were screened through the Critical Appraisal Skill Program (CASP) tool from which 26 articles were excluded. The exclusion of the 26 articles was based on having non-focused measured outcomes as well as systematic reviews that evaluated interventions and in which RCTs were not selected. This led to the selection of seven articles, namely, a prospective randomised multicentre study, a prospective randomised clinical study, a randomised controlled pilot study, a prospective randomised study, a prospective randomised open-label trial, a randomised control trial and a systematic review and meta-analysis. These articles were critically appraised through the CASP tool for Randomised Controlled Trial (RCT) and CASP tool for Systematic Review. The researchers concluded that continuous bed rotation (CLRT and KT) is more effective than standard turning practices in the reduction of respiratory complications. It was highlighted that further research in this field of practice is crucial. Conducting qualitative and quantitative research, promote a learning culture, knowledge sharing and a patient- family-nurse relationship will lead to an effective project implementation.