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A prospective, randomized trial of continuous lateral rotation (kinetic therapy) in patients with cardiogenic shock
Clinical Research in Cardiology, 06/26/2012
Simonis G et al. – The use of kinetic therapy (KT) reduces rates of pneumonia and pressure ulcers as compared to standard care (SC). Moreover, in this study, patients with KT had a better outcome. The study suggests that KT should be used in patients with cardiogenic shock requiring ventilator therapy for a prolonged time.
Methods- A prospective, randomized, open–label trial was performed to compare KT using oscillating beds (TryaDyne Proventa, KCI) with standard care (SC).
- Patients with cardiogenic shock requiring ventilator therapy for more than 24 h were included.
- Primary endpoint was the occurrence of hospital–acquired pneumonia.
- Secondary endpoints were the occurrence of pressure ulcers during the hospital stay and 1–year all–cause mortality.
- 45 patients were randomized to KT, and 44 to SC.
- All patients required at least one inotropic agent and one vasopressor for circulatory assistance.
- The groups were comparable in the etiology of heart disease, in the use of revascularization procedures, the use of balloon counterpulsation, and APACHE–II score (33 ± 5 vs. 33 ± 4) and SOFA score (11 ± 1 vs. 11 ± 1) at inclusion; however, more patients in SC were subject to resuscitation before inclusion.
- Hospital–acquired pneumonia occurred in 10 patients in KT and 28 patients in SC (p < 0.001); pressure ulcers were seen in 10 versus 2 patients (p < 0.001).
- Hospital mortality tended to be lower in KT, and 1–year all–cause mortality was 41 % in KT and 66 % in SC (p = 0.028).