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Do kinetic beds prevent nosocomial pneumonia?

Citation: Demarest GB, et al. Use of the kinetic treatment table to prevent the pulmonary complications of multiple trauma. West. J Med. 1989 Jan;150(1):35-8.
 

Lead author's name: Demarest GB

Three-part Clinical Question:

Patients: trauma patients in a ICU

Intervention: rotating bed v. conventional bed

Outcome: incidence of pneumonia – both community and hospital acquired
 

Search Terms: Intensive care, critical care, mechanical ventilation, ventilator-associated pneumonia, nosocomial pneumonia, prevention, controlled trial

The Study: Non-blinded, randomised trial without intention-to-treat.
 

The Study Patients: 37 critically ill trauma patients; 30 analysed
 

Control group N = 14
 

Experimental group N = 16

The Evidence:

Comments:

There was not an intention-to-treat analysis.

There was no blinding.

The diagnosis of pneumonia was made on a combination of purulent sputum, X-ray changes and fever. There was no bacterial confirmation. These signs are non-specific, especially in trauma victims. The poor definition of pneumonia undermines the validity of the study. Both community and hospital –acquired pneumonias would have been included.

No power calculation was done.

The authors retrospectively analysed a sub-group of patients with initially clear CXRs. However their conclusions are invalid.

The poor design of this study prevents inclusion in a robust meta-analysis.

Appraised by: David Swann, Consultant, ICU, Royal Infirmary of Edinburgh

Email: d.g.swann@ed.ac.uk

Kill or Update By: December 2009

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