PICOT STUDY PROFESSOR NAME A. Introduction Pulmonary complications are quite common in critically ill patients, and this is especially so in patients with intubation and who are mechanically ventilated. Among the common complications are atelectasis, hypoxia and nosocomial infections…
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In spite of its continued use, no evidence exists as to its effectiveness in improving pulmonary complications (Vollman, 2010). Continuous lateral rotation therapy has been in use as part of progressive mobility and has been employed in an effort to reduce pulmonary complications resulting from immobility. This therapy was delivered through a continuous motion-bed frames that helped rotate the patient from one side to another. Studies have demonstrated the effectiveness of the therapy in improving pulmonary outcomes in critically ill patients (Sahn, 1991). The mobilization of patients is a broadly accepted practice helping reduce the effect of prolonged bed rest. In spite of this, it is usually difficult to mobilize patients during early acute phases of their illness. CLRT can be used to make up for this deficiency by providing early mobility efficiently to those patients whose critical condition or instability makes it hard to use other forms of mobility. There are several criteria which have been proposed in identifying pulmonary patients who could potentially benefit from CLRT. Methods that can be evaluated quickly and simply are preferred owing to ease in their implementation especially in busy critical-care environments. An example of such a method includes calculation of PaO2/ FIO2 ratio. This ratio shows the effectiveness of transfer of oxygen from the lungs to the hemoglobin in the blood. If this ratio is more than 300, the patient is considered to have minor pulmonary insufficiency, but if the ratio is less than 300, the patient is considered to have acute lung injury. The lower the ratio is, the worse the pulmonary function and vice versa. Setting the desired ratio as 300 helps to achieve the goal of early intervention instead of waiting till the patient deteriorates further. Additionally, other criteria include evaluation of the patients’ oxygen and PEEP requirements so as to achieve normal levels of PaO2. A radiograph is useful to assess for the presence of infiltrates and atelectasis. Bedside staff can easily evaluate these criteria. The most important consideration in the evaluation of potential CLRT patients is consistent assessment of the established criteria basing on the established set standards within the institution. The development of clinical practice outlines, standard of care or care bundle enables consistent implementation and helps improve outcomes. All the members of the care team are to participate actively in the identification of patients who would profit from early progressive mobility therapies like CLRT. Continuous education, evaluation and bedside mentoring are required to effect implementation of new or updated standard or practice( Sandra, 2012). When patients have been identified as suitable candidates for CLRT, there are many obstacles that impede the implementation of CLRT. Often times, transferring a patient from one bed to another seems a difficult task, what with the tubing, the branular and equipment that are connected to the patient. Additionally, those caregivers who will physically lift the patient are exposed to physical risk. There is also time lag between the moment when a patient is identified as suitable for CLRT and receipt of a suitable bed for performing a CLRT. This therefore calls for availability of ready beds capable of CLRT in the intensive care units so that there would be no need for multiple transfers from one bed to another. This would in effect minimize delays. In case such
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