Prone positioning developed to the most hopeful therapeutical approach in the treatment of severe respiratory failure. Different types of kinetic therapy are practiced, but not every method can be used in any patient. Instable pelvic fractures, aortic rupture, prominent external fixation, obesity, e.g., does sometimes not allow one to turn a patient to the prone position. With a new kind of kinetic bed (Rotoprone®) more patients can treated in prone position. First experiences, benefits and problems will be reported.
Patients and methods
In an open prospective study we observed from July 1999 until June 2000 eight polytraumatized patients in the ICU of the Trauma-Center-Marburg with severe post-traumatic respiratory failure, undergoing prone positioning by using the Rotoprone®. Severity of injury and clinical course were defined through the Injury-Severity-Score (ISS), APACHE-II-Score and the Therapeutic-Intervention-Scoring-System (TISS). The mean ISS was 39.8(19/52), the APACHE-II-Score on the time of admission was 20.3(19/23) and the TISS was 28.3(43/25). All patients were male. The mean age was 39.8(19/66). The average time of beginning the Rotoprone®-therapy was on the 8.8th day (2/21), the average time of respiratory support was 33.4th day (18/59). The mean time on ICU was 36.6(22/62) days. Only one patient died on ICU due to multiple organ failure.
Using the SOFA-Score/lung (PaO2/FiO2) for measuring the respiratory function we found a value of 170 (93/228) at the beginning of prone positioning with the expected improvement to values of 301(265/375) at the end of kinetic therapy. Just in one case we had to discontinue the use of Rotoprone® due to a malfunction of the security-mechanism.
Edema of face and neck, pressure induced necrosis, hypotension or arrhythmia never reached such an extent that we had to end kinetic therapy.
This bed is a new and promising tool in treatment of severe respiratory failure. Some patients who require kinetic therapy in the extent of prone positioning who could so far not be turned – due to different reasons – could now be treated. High costs, difficult handling and few available beds are so far limiting factors.