The Acute Effect of Body Positions Strategies and the Respiratory Therapy - Research Paper Example

Pulmonary complications account for quite a large number of mortality and morbidity in critically ill patients, in which case it is common in patients with intubation and who experience mechanical ventilation. Hypoxia, atelectasis, and nosocomial infections are the most frequent complications amongst critically ill patients. Therefore, the purpose of this paper is to describe the evidence that continuous lateral rotation is quite effective than no rotation in the prevention of acute respiratory distress syndrome and lung injury patients who are critically ill. This is through the review of the literature using the PICOT question, in which case it is essential in looking for evidence that supports an intervention (Vollman, 2010). The picot question involves the following elements

P – Intubated patients in the intensive care unit

I – Use of continuous lateral rotation therapy

C – Not using the continuous lateral rotation therapy in intubated patients

O – Preventing acute lung injury and ARDS

T – Time in demonstrating the outcome

The intubation procedure should involve the gas exchange, the hemodynamic and neurologic care, in which case they are essential in critically ill patients (Vollman, 2010). The evidence provided is quite of high level and results in answering the PICOT questions. The application of CLRT is quite easier to maintain, and hence, the application of CLRT leads to the prevention of atelectasis than it restores the alveolar patency. The inclusion criteria included all the search results, in which case it had to contain continuous lateral therapy and lung injury, lung complications, and ARDS (Davis et al., 2001).

PART B

Introduction

Pulmonary complications are the most frequent in mortality and morbidity in critically, ill patients. Studies by the Institute for Healthcare Improvement have had to find that ventilator-associated pneumonia is leading in the cause of hospital morbidity and mortality. Nurses have even had to implement a two-hour turning of patients in order that they prevent complications. Despite the continued use of such strategies, there has been no significant improvement in the effectiveness of pulmonary complications. As part of the progressive mobility, Continuous Lateral Rotation Therapy (CLRT) has been in use in order to reduce the pulmonary complications that have had to result from immobility. The therapy was through continuous motion-bed frames, in which case helps rotate the patient from one side to another. Such a strategy is quite effective in improving the pulmonary outcomes in critically ill patients (Dollovich, et al, 1998).

Synthesizing Evidence

Methods

Mobilization of patients is quite an accepted practice that helps to reduce the effect of prolonged bed rest. Sometimes it is quite difficult to mobilize patients during the early acute phase of their illness. CLRT can be useful for the deficiency. This is by providing early mobility to the patients whose critical condition or instability makes it hard to use any other forms of mobility.

From the evidence table, several criteria help in identifying pulmonary patients who could be potential beneficiaries of CLRT. Methods evaluated simply and quickly are the ones, in which case one can prefer owing to the ease in the implementation, and this is especially in busy critical-care environments. For instance, such a method as calculation of the PaO2/FIO2 ratio is quite an excellent example. The ratio will show the effectiveness of the transfer of oxygen from the lungs to the hemoglobin in the blood. The patient might have minor pulmonary insufficiency if the ratio becomes more than 300. However, if the ratio becomes less than 300, the patient might have an acute lung injury. This implies the lower the ratio, the worse the pulmonary function and conversely. Having a ratio of 300 is quite significant in achieving the goal of early intervention rather than waiting until the patient deteriorates. The other criteria involve evaluation of the patient’s oxygen and the PEEP requirements in order to achieve normal levels of PaO2. Radiography will function in assessing the presence of infiltrates and atelectasis. Conducting the evaluation includes the bedside staff (Martin, 2001).

The most distinguished consideration in the evaluation of potential CLRT patients involves consistent assessment of the established criteria basing on the established set standards within the institution. Development of the clinical practice outlines, standards of care, or the care bundle ensures consistent implementation and helps improve outcomes. All members of the care team must participate in the identification of patients who would profit from the early progressive mobility therapies like CRPT. There must be continuous education, evaluation, and bedside mentoring in order to affect the implementation of new or updated standards or practices.

After identifying suitable patients for CLRT, there exist obstacles in the implementation of CLRT. Transferring patients from one bed to another might be a difficult task, including tubing, the branular, and equipment connected to the patient. There might be a physical risk while lifting the patient.

Since the flow of blood and the gas distribution are by gravity, a lot of blood will move to the alveolar in the dependent lung position. Therefore, this will optimize gaseous exchange, and hence, enhancing oxygenation (Hanneman, 2012).