AUTOMATIC ROTATIONAL THERAPY IN MECHANICALLY VENTILATED INDIVIDUALS AND LONG STAY IN AN INTENSIVE CARE UNIT: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background

Invasive ventilatory support and prolonged immobility in bed are predictive factors for the development of respiratory and musculoskeletal complications in critically ill patients, favoring increased length of hospital stay, morbidity and mortality, and costs associated with long hospital stays.

Objectives

To evaluate the impact of automatic rotational therapy on length of stay in the intensive care unit (ICU) in mechanically ventilated patients.

Methods

Systematic review conducted from December to January 2023 with randomized clinical trials, following criteria reported in PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) registered in PROSPERO (CRD42022384258). The search strategy was built based on health sciences descriptors (DeCS), Medical Subject Headings (MeSH), keywords and synonyms most found in the literature. The search was carried out in seven databases: MEDLINE/PubMed, EMBASE, Scopus, Science Direct, Cochrane Library, CINAHL, and Web of Science. The eligibility criteria involved studies that evaluated automatic rotational therapy compared with changing the manual decubitus position during the length of stay in the ICU in individuals of both genders aged 18 years or older using invasive mechanical ventilation for a period. greater than 24 hours. There was no restriction on language or year of publication. The risk of bias was assessed using the Cochrane collaboration tool.

Results

118 articles were identified, after excluding duplicates and reading in full, 9 were eligible, involving 679 participants. The number of individuals evaluated per article ranged from 27 to 124 in the control and intervention groups. For meta-analysis, four studies were included, totaling 323 participants. The standardized mean (SMD) difference was -0.03 days (95% CI -0.40, 0.35, p=0.90) between automatic rotational therapy and conventional recumbency, with no significant difference between groups with high evidence of overall heterogeneity (χ2 8.26, p= 0.04, I2 = 64%).

Conclusion

Automatic rotational therapy did not have a significant impact on the length of stay in the ICU in mechanically ventilated critical patients. Therefore, it is not possible to make definitive recommendations on this therapy, reinforcing the need for new randomized clinical trials to better answer the research question.

Implications

The development of this systematic review and meta-analysis enabled the expansion of knowledge about the possible benefits of automatic rotational therapy in critically ill patients, for future contributions to the scientific community and, due to the high heterogeneity between studies, it is shown as a field to be explored in future studies.