A recent meta-analysis published in Respiratory Care indicates that continuous lateral rotation therapy (CLRT) does not significantly improve mortality, length of intensive care unit (ICU) stay, or length of hospital stay in critically ill adults undergoing mechanical ventilation (MV). The study, which analyzed data from 18 trials involving 1466 participants, challenges the perceived benefits of CLRT for these primary outcomes.
The meta-analysis included 16 randomized clinical trials and 2 quasi-randomized clinical trials, comparing CLRT to conventional positioning methods in ICU patients requiring invasive ventilatory support. The primary outcomes assessed were mortality, ICU length of stay, and hospital length of stay.
No Significant Impact on Mortality or Length of Stay
The results showed that CLRT did not yield significant differences in mortality (odds ratio [OR], 1.04; 95% CI, 0.80-1.34; P = .77). Similarly, there was no significant decrease in the length of ICU stay (standardized mean difference [SMD], –0.11 days; 95% CI, –0.25 to 0.02; P = .11) or hospital stay (SMD, –0.10 days; 95% CI, –0.31 to 0.11; P = .33).
Benefits in Ventilation Duration and Pneumonia Incidence
However, the analysis revealed that CLRT was associated with a shorter duration of mechanical ventilation. Based on 10 studies, the standardized mean difference was –0.17 days (95% CI, –0.29 to –0.04; P = .008), indicating a statistically significant reduction in ventilation time with CLRT.
Furthermore, the incidence of ventilator-associated pneumonia was significantly lower in patients receiving CLRT. An evaluation of 11 studies showed an OR of 0.39 (95% CI, 0.29-0.52; P < .00001), suggesting a substantial decrease in the probability of pneumonia with CLRT.
Study Limitations and Implications
The researchers noted that the certainty of evidence for mortality and length of hospital stay was very low, while the certainty for the length of ICU stay was moderate. These limitations underscore the need for further high-quality research to validate these findings.
"This meta-analysis on the efficacy of CLRT in critically ill patients undergoing MV reveals no significant superiority over conventional protocols for primary outcomes, with very low certainty for mortality and length of hospital stay, and moderate certainty for the length of ICU stay," the researchers concluded. While CLRT may offer benefits in terms of reduced ventilation duration and pneumonia incidence, its impact on key outcomes like mortality and length of stay remains uncertain.
