Hemodynamic changes associated with manual and automated lateral rotation in mechanically ventilated intensive care patients
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Dr. Shannan K. Hamlin, PhD, RN, ACNP-BC, AGACNP - BC, CCRN, NE-BC
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- Zeta Pi
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Abstract
Objective: To investigate hemodynamic responses to lateral rotation.
Design: Time-series within a randomized controlled trial pilot study.
Setting: A medical intensive care unit (ICU) and a medical-surgical ICU in two tertiary care hospitals.
Patients: Adult patients receiving mechanical ventilation.
Interventions: Two-hourly manual or continuous automated lateral rotation.
Measurements and Main Results: Heart rate (HR) and arterial pressure were sampled every 6 seconds for > 24 hours, and pulse pressure (PP) was computed. Turn data were obtained from a turning flow sheet (manual turn) or with an angle sensor (automated turn). Within-subject ensemble averages were computed for HR, mean arterial pressure (MAP), and PP across turns. Sixteen patients were randomized to either the manual (n = 8) or automated (n = 8) turn. Three patients did not complete the study due to hemodynamic instability, bed malfunction or extubation, leaving 13 patients (n = 6 manual turn and n = 7 automated turn) for analysis. Seven patients (54%) had an arterial line. Changes in hemodynamic variables were statistically significant increases ( p < .05), but few changes were clinically important, defined as ≥ 10 bpm (HR) or ≥ 10 mmHg (MAP and PP), and were observed only in the manual-turn group. All manual-turn patients had prolonged recovery to baseline in HR, MAP and PP of up to 45 minutes (p ≤ .05). No significant turning-related periodicities were found for HR, MAP, or PP. Cross-correlations between variables showed variable lead-lag relations in both groups. A statistically, but not clinically, significant increase in HR of 3 bpm was found for the manual-turn group in the back compared with the right lateral position ( F = 14.37, df = 1, 11, p = .003).
Conclusions: Mechanically ventilated critically ill patients experience modest hemodynamic changes with manual lateral rotation. A clinically inconsequential increase in HR, MAP, and PP may persist for up to 45 minutes. Automated lateral rotation has negligible hemodynamic effects.
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This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3420488; ProQuest document ID: 749218778. The author still retains copyright.
Repository Posting Date
2020-02-20T16:01:35Z
Notes
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Type Information
Type | Dissertation |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Category Information
Evidence Level | Randomized Controlled Trial |
Research Approach | Quantitative Research |
Keywords | Patients on Ventilation; Affects of Physical Rotation; ICU Patients |
CINAHL Subject(s) | Blood Pressure; Heart Rate; Respiration, Artificial; Blood Pressure--Evaluation; Heart Rate--Evaluation |
Degree Information
Grantor | The University of Texas School of Nursing at Houston |
Advisor | Hanneman, Sandra K. |
Level | PhD |
Year | 2010 |
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