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Do kinetic beds prevent nosocomial pneumonia?

Citation:

Gentilello L, et al. Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med 1988;16:783-786.
 

Lead author's name: Gentilello L

Three-part Clinical Question:

Patients: trauma patients in a surgical 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: 65 critically ill trauma patients
 

Control group N = 38; all analysed
 

Experimental group N = 27; all analysed

The Evidence:

Comments:

Patients were randomised to a treatment group, with a provision to cross over to the other group if a complication occurred. It seems that only one patient dropped out of the experimental and was not analysed. The cross-over rate is not explicitly stated. There was not an intention-to-treat analysis.

By chance there were 63% smokers in the control group & 30% in the experimental group.

The patients were followed up for 4 days after mobilisation or at death. The diagnosis of pneumonia was made on a combination of clinical, lab and radiological findings. Only the radiologist was blinded to the treatment group. Both community and hospital –acquired pneumonias would have been included.

No power calculation was done.

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

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

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

Kill or Update By: December 2009

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