Lateral Rotation Mattresses for Wound Healing
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M attresses and beds that move the patient in a regular pattern around a longitudinal (ie, head to foot) axis are variably referred to as lateral rotation, continuous lateral rotation therapy, oscillating therapy, or kinetic therapy. Although these terms are often used synonymously, one defined technical difference has been noted. According to the Centers for Disease Control's Guideline for the Prevention of Nosocomial Pneumonia,1 kinetic therapy refers to rotation of 40 degrees or more to each side (for an arc of 80 degrees), and continuous lateral rotation therapy rotates up to 40º to each side (up to an 80-degree arc). These specialized mattresses and beds have been used for more than 30 years, mainly in the prevention and treatment of cardio-respiratory conditions in ICU patients. Anecdotally, they have been used to treat skin breakdown in the bedridden, difficult-to-reposition patient. However, scant evidence in the literature addresses the incidence of skin breakdown or the treatment outcome of skin breakdown using these mattresses.
History of the Design
The original design for a rotating bed frame was incorporated in the RotoRest® (Kinetic Concepts Inc., San Antonio, Tex.). This bedframe-and-surface device secures patients in a supine position and rolls or rotates them from left side to right side in a 124-degree arc, or 62 degrees in each direction. Since that time, many devices that turn the patient around a longitudinal axis using various means have been developed. These include other full combination bedframe-and-surface devices and replacement mattresses that turn the patient using either air inflated tubes or pillows. Angles of achievement vary from 60-degree arc, or 30 degrees in each direction, up to the aforementioned 124-degree arc. As a group, these surfaces are commonly referred to as continuous lateral rotation (CLR) or continuous lateral rotation therapy (CLRT).
Other powered support surfaces that are widely used for wound care have been developed, such as low-air-loss and alternating pressure. They are commonly used during the treatment of pressure ulcers, specifically those on the trunk and pelvis, per Medicare guidelines for Group II surfaces.2 The difference between alternating pressure and CLRT is in the pattern of inflation/deflation (see Figure 1).
Cardio-respiratory issues. Research published since 1980 on various CLRT surfaces has centered on cardio-respiratory issues such as decreasing the incidence of atelectasis, pneumonia, and pulmonary compromise in the immobilized patient.3 Despite the number of studies published, drawing firm conclusions is difficult because of the variety of patient populations, bed or mattress features, degrees of patient movement, physiological markers used to identify changes, and results obtained (see Table 1 and Table 2).
1. Tablan O, Anderson L, Arden N, Breiman R, Butler J, McNeil M. Hospital Infection Control Practices Advisory Committee. Guideline for Prevention of Nosocomial Pneumonia. Centers for Disease Control.1994.
2. Durable Medical Equipment Regional Carrier (DMERC) Region C Supplier Manual.
3. Basham K, Vollman K, Miller A. To everything turn, turn, turn. . . an overview of continuous lateral rotational therapy. Resp Care Clin North Am. 1997;3(1):109-134.
4. Schimmel L, Civetta J, Kirby R. A new mechanical method to influence pulmonary perfusion in critically ill patients. Care Med. 1977;5(6):277-279.
5. Bein T, Reber A, Metz C, Jauch KW, Hedenstierna G. Acute effects of continuous rotational therapy on ventilation-perfusion inequality in lung injury. Intensive Care Med. 1998;24:132-137.
6. Gentilello L, Thompson DA, Tonnesen AS, et al. Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med. 1988;16:783-786.
7. Clemmer TP, Green S, Ziegler B, et al. Effectiveness of the kinetic treatment table for preventing and treating pulmonary complications in severely head-injured patients. Crit Care Med. 1990;18:614-617.
8. Fink MP, Helsmoortel CM, Stein KL, et al. The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma: a prospective study. Chest. 1990;97:132-137.
9. Nelson L, Anderson H. Physiologic effects of steep positioning in the surgical intensive care unit. Arch Surg. 1989;124:352-355.
10. deBoisblanc BP, Castro M, Everett B, et al. Effect of air-supported, continuous postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest. 1993;103:1543-1547.
11. Traver G, Tyler M, Hudson L, Sherrill D, Quan S. Continuous oscillation: outcome in critically ill patients. J Crit Care. 1995;10(3):97-103.
12. Whiteman K, Nachtmann L, Kramer D, Sereika S, Bierman M. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care. 1995;4(2):133-139.
13. Raoof S, Chowdhrey N, Raoof S, et al. Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest. 1999;115:1658-1666.
14. Russell T, Logsdon A. Pressure ulcers and lateral rotation beds: a case study J WOCN. 2003;30(3):143-145.
15. Davis K, Johannigman JA, Campbell RS, et al.The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. Crit Care. 2001;5:81-87.
16. Staudinger T, Kofler J, Mullner M, et al. Comparison of prone positioning and continuous rotation of patients with adult respiratory distress syndrome: results of a pilot study. Crit Care Med. 2001;29(1):51-56.
17. Summer WR, Curry P, Haponik EF, Nelson S, Elston R. Continuous mechanical turning of intensive care unit patients shortens length of stay in some diagnostic-related groups. J Crit Care. 1989;4:45-53.
18. Kirschenbaum L, Azzi E, Sfeir T, Tietjen P, Astiz M. Effect of continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-term ventilatory care. Crit Care Med. 2002;30:1983-1986.
19. Sahn S. Continuous lateral rotational therapy and nosocomial pneumonia. Chest. 1991;99:1263-1267.
20. Krishnagopalan S, Johnson W, Low L, Kaufman L. Body positioning of intensive care patients: Clinical practice versus standards. Crit Care Med. 2002;30:2588-2592.
21. Choi SC, Nelson LD: Kinetic therapy in critically ill patients: combined results based on meta-analysis. J Crit Care. 1992;7:57-62.
22. Izutsu T, Matsui T, Satoh T, Tsuji T, and Sasaki H. Effect of rolling bed on decubitus in bedridden nursing home patients. Tohoku J Exp Med. 1998;184:153-157.
23. Branom R., Rappl L. "Constant force technology" versus low-air-loss therapy in the treatment of pressure ulcers. Ostomy/Wound Management. 2001;47(9):38-46.
24. Bolton L, McNees P. Wound healing outcomes using standardized care. Poster presented at WOCN 2003, Cincinnati, Ohio. June 14-18, 2003.