Pilot Study of Lateral Rotation Interventions for Efficacy and Safety in ICU Care

Multi-site Randomized Clinical Trial of Horizontal Positioning to Prevent and Treat Pulmonary Complications in Mechanically Ventilated Critically Ill Patients

Intensive care unit (ICU) patients on respirators are at high risk for preventable pulmonary complications (PPC). Turning these patients from side to side may reduce PPC, but carries the burden of decreases in blood pressure and oxygenation. The investigators hypothesize that there will be no difference in PPC or adverse events when ICU patients on respirators are turned by nurses or by an automated turning bed.

The purpose of this pilot study is to test the feasibility of two turning protocols and study procedures for a multi-site randomized clinical trial to evaluate efficacy and safety of horizontal positioning interventions to reduce pulmonary complications in mechanically ventilated critically ill adult patients. The hypothesis of the randomized controlled trial (RCT) is no difference in pulmonary complications between manual, 2-hourly lateral rotation to > 45 degrees (control), and continuous automated turning to 45 degrees (experimental) groups.

Inclusion Criteria:

• receiving mechanical ventilation
• ability to place on study protocol within 8 hours of intubation

Exclusion Criteria:

• pulmonary mass, pneumothorax, hemothorax, pleural effusion, or other source of compression atelectasis at time of assessment for eligibility
• systolic blood pressure < 90 mmHg with vasopressor support
• orthopedic injuries requiring limited or complete immobilization
• head injury requiring intracranial pressure monitoring
• unstable spinal injuries
• rib fractures
• body weight > 350 lbs
• intubation within the previous 2 weeks