The role of positioning in the prevention and therapy of ALI and ARDS in polytrauma patients: results of a prospective study with 100 cases
© Current Science Ltd 1998
Published: 1 March 1998
Since its introduction into intensive care medicine in the early 80s, the positive effects of kinetic therapy have been proven in different patient groups. However, polytrauma patients with severe chest injuries have not yet been studied in large numbers. According to the principles of evidence based medicine, only a small body of literature exists. With this in mind, we planned to create a greater data base in this subgroup of trauma patients to work out a baseline for an evidence based level I study.
From 1994 to 1997, in a consecutive series 100 patients were treated in an open prospective trial with a standardized protocol including therapy guidelines for the application of either kinetic therapy or prone positioning. There were 73 male and 27 female patients with a mean age of 35 years. In 80% of the cases, a traffic accident was the cause of injury. The severity of trauma and illness in this group was characterized by an ISS (injury severity score) of 35 (15–75) and an APACHE II of 11 (6–28) on the first day. Outcome predictors were ventilation time, stay on the ICU and in hospital, as well as total hospital mortality. A short-term outcome parameter was an increase of PaO2/FiO2 ratio in the first 72 h.
100 patients were treated with this concept in a kinetic bed with positioning. Whenever possible, extreme positioning of 60° was used, in 10 patients with severe atelectasis prone positioning was performed in addition for a mean time of 2 days. The mean treatment time in the kinetic bed was 5 days (2–21), the time on ventilator therapy was 12 (3–62), length of stay on the ICU 18 (5–67) days and in hospital 28.5 (8–220) days. Positive PaO2/FiO2 ratio changes in the first 72 h of the therapy were observed in 70% of patients. Mortality in the treatment group was 10%. Cause of death in all patients was the development of multiple organ failure.
Analysing our results, we found a much better outcome than predicted by the initial scoring in this severly injured patient group. The rate of secondary lung damage was very low. According to our findings, standardized kinetic therapy is one approach to improve the outcome in polytrauma patients by reducing severe pulmonary complications.