Evaluation of kinetic therapy in the prevention of complications of prolonged bed rest secondary to stroke.

Abstract

We performed a prospective, controlled study of kinetic therapy in acute, severe stroke. This therapy involved continuous mobilization of a bedridden patient by means of a specially designed rotating bed. All patients with acute stroke presenting to the Neurology Service over an 18-month period were screened, and those that qualified were assigned to confinement in either a routine hospital bed or a rotating bed. We found that the most common complication of stroke with bed confinement of 4 days or longer was bacterial infection consisting of either pneumonia, sepsis, or urinary tract infection. The two variables found to be of greatest significance in affecting the rate of infection were length of bed confinement, especially for > 13 days (2.3-fold increased risk, p<0.04), and placement in a routine hospital bed (2.9-fold increased risk, p = 0.023). (Stroke 1987;18:638-642)

Aetiology of fever in patients with acute stroke *

“…In general, prior use of an invasive technique was strongly associated with development of infection, as expected. The high prevalence of urinary tract infections in patients with more severe stroke is related to their impaired ability to empty the bladder, resulting in stasis of urine, which, in addition, often negates the use of a urinary catheter [13, 14]. Our data show that insertion of a urinary catheter significantly increased the risk for urinary tract infection and suggest caution in the use of this common (and sometimes unnecessary) invasive technique.…”

Manual Turns in Patients Receiving Mechanical Ventilation

“…40 These authors similarly report issues with low methodological quality in the trials reviewed and an inability to make universal recommendations for the use of rotational therapy. 40 Goldhill and colleagues 40 indicate that rotational therapy decreased urinary tract infections in 2 of the trials 42,43 included in the review. In 2 other systematic reviews that do not specifically address patients receiving mechanical ventilation, continuous lateral rotation therapy (CLRT) was compared with manual turning with a focus on ICU patients.…”

Ventilator-associated pneumonia

“…The efficacy of this preventive measure, has been investigated in a model of ventilated baboons by ANZUETO et al [2] with positive results. I have found six randomized studies [3][4][5][6][7][8] in which rotational therapy was compared to standard therapy for the prevention of VAP. In most of these studies there was a decreased incidence of VAP with rotational therapy.…”