EFFECT OF CONTINUOUS LATERAL ROTATIONAL THERAPY ON LUNG MUCUS TRANSPORT IN MECHANICALLY VENTILATED PATIENTS

Purpose: Continuous lateral rotational therapy (CLRT) < 40 degrees is a method of altering the position of the ventilated patient to help cl ear secretions from the lung. CLRT has not been shown to reduce the in cidence of atelectasis or pneumonia but potentially offers a way to ma ximize positional drainage in these patients without producing adverse effects. Treatment intervention, bracketed by two (nonrotational) con trol periods. The purpose of this study was to determine if CLRT alter s mucus transport in critically ill, intubated patients in the intensi ve care unit of a teaching hospital. Materials and Methods: Thirteen c ritically ill, but stable, mechanically ventilated patients, mean age 74 years, were enrolled. They were placed supine on a Biodyne bed (KCI , San Antonio, Texas) and pressures in the cushions adjusted to patien t's weight. A radiolabeled aerosol was delivered by bagging for 2 to 3 minutes and repeated measurements of lung radioactivity were obtained by imaging of the thorax over the following 3 hours. A 90-minute peri od of rotation of the bed, 30 degrees to either side was preceded and followed by two 45-minute control periods during which the patient rem ained supine and stationary on the bed. Coughs and suctions were recor ded and blood gases obtained pre and post study. Results: (1) The muco us clearance was slower than that reported in normal subjects and in a mbulatory patients with COPD; (2) there was a slight, but not signific ant, increase in clearance during CLRT; (3) clearance reverted to pre- oscillation levels following therapy. Lack of significant effect may b e attributed to too shallow an angle for rotation or too short an inte rvention period. Conclusion: Positional drainage effected by short dur ation CLRT did not appear to stimulate significant mucous removal from the lung in critically ill patients but also did not cause any advers e effects. Copyright (C) 1998 by W.B. Saunders Company.