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Kinetic therapy in Germany: results of a randomized cross-sectional survey

Introduction

Prone positioning developed to the most hopeful therapeutical approach in the treatment of severe respiratory failure. Different types of kinetic therapy are practiced, but so far no data are available about the real number of institutions that practice kinetic therapy in the treatment of respiratory failure and which sort of therapy is practiced. For the first time we present representative data of the number of clinics that practice kinetic therapy in Germany. Eighty-six per cent of all answering clinics practice prone positioning. The mean time for positioning was 17 min, the mean duration was 4.8 hours. Mostly a usual ICU bed was used. No severe unexpected events were reported. The estimation of this sort of treatment was mostly good (62%) and very good (32%).

Methods

In order to evaluate the incidence of kinetic therapy in the treatment of respiratory failure in Germany we initiated a randomized survey, including all 1589 German ICUs. Following a regional randomization, to achieve a representative distribution of the hospitals we divided into four groups of ICUs: surgical = SICU (52), anaethesiological = AICU (15), medical = MICU (52) and multidisciplinary = MdICU (124). According to statistical analysis we sent a standardized questionnaire to 201 hospitals, enough to receive representative results. For statistical analysis the Chi-Quadrat test, the exact Fischer test, and the Wilcoxon test/Kruskal–Wallis test, following the NPAR1WAY procedure, were used. We asked what sort of bed was used, how often and how long prone positioning was performed, how many nurses were involved and the time it took for positioning and the duration of prone therapy. Additionally we asked for the indications and main complications of prone/kinetic therapy. Finally we asked for the general estimations of kinetic therapy.

Results

Most of the ICUs were MdICU (124), followed by SICU (52), AICU (15) and MICU (nine). One hundred and seventy-three (86%) ICUs practice kinetic therapy, only 28 ICUs (14%) did not; 79% (136 ICUs) used a normal bed for kinetic therapy, just 6% (11 ICUs) used special beds for prone positioning. Rotorest® beds (side-to-side) were used by only 2% (three ICUs). In 23% (15 ICUs), special beds like water beds, rotational beds or similar were used. Usually three persons were needed to turn a patient into prone positioning, with a mean time of 17 min (SD 9.28), Prone positioning lasted 4.8 hours (SD 2.82), with a maximum of 10.27 hours. ARDS/ALI (58%) were main indications for kinetic therapy. In 18% it was used on prophylactic purposes. Main complications were welling (35%), skin lesions (32%) and short-time hemodynamic instability (13%). The estimation of kinetic therapy and its value in the treatment of respiratory failure was good (62%) and very good (32%).

Conclusion

For the first time we present representative data of the number of clinics that practice kinetic therapy in Germany. Eighty-six percent of all answering clinics practice prone positioning. The mean time for positioning was 17 min, and the mean duration was 4.8 hours. Mostly a usual ICU bed was used. No severe unexpected events were reported.

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Baacke, M., Floren, M., Ose, C. et al. Kinetic therapy in Germany: results of a randomized cross-sectional survey. Crit Care 7, P171 (2003). https://doi.org/10.1186/cc2060

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  • DOI: https://doi.org/10.1186/cc2060

Keywords

  • Respiratory Failure
  • Prone Position
  • Representative Data
  • Hemodynamic Instability
  • Main Complication