title: Manual vs automated lateral rotation to reduce preventable pulmonary complications in ventilator patients.
abstract: OBJECTIVE
  To estimate effect sizes for a trial to compare preventable pulmonary complications (PPCs), turning-related adverse events, mechanical ventilation duration, intensive care unit (ICU) length of stay, and ICU mortality between patients randomized to 2-hourly manual or continuous automated lateral rotation.
  
  
  METHODS
  Randomized controlled trial pilot study with 15 patients selected randomly from eligible medical-surgical ICU patients from 2 tertiary hospitals and assigned randomly to the manual-turn or automated-turn protocol for up to 7 consecutive days. A radiologist blinded to group and site assessed serial chest radiographs for PPCs. Repeated-measures analysis with linear mixed models was used to estimate change in PPC score, and Wilcoxon rank sum or Fisher exact test was used to compare group differences in the secondary outcomes.
  
  
  RESULTS
  Of 16 patients enrolled, 12 (75%) completed the study. Data from 15 patients, 7 manual turn and 8 automated turn, were analyzed. Between-group differences in PPC incidence (67% overall), change in PPC score (β = 0.15, manual turn and β = -0.44, automated turn), and secondary outcomes were not significant (P > .05). Standardized effect sizes were small to moderate for the outcome variables. A sample size of 54 patients would be needed to detect statistically significant between-group differences in PPC over time.
  
  
  CONCLUSIONS
  The incidence of PPCs in adult patients receiving mechanical ventilation in a medical-surgical ICU was high. Automated turning decreased PPCs with time but had little effect on secondary outcomes. Safety outcomes were not substantially different between groups. A modest efficacy effect supported reduced PPCs with automated turning to the lateral position.
authors.affiliation: Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research at University of Texas Health Science Center at Houston School of Nursing. Gary M. Gusick is a clinical nurse specialist in cardiovascular and transplant nursing at St Luke's Episcopal Hospital, Houston, Texas. Shannan K. Hamlin is program director of nursing research and evidence-based practice at Houston Methodist Texas Medical Center. Sheryln J. Wachtel is director of innovation and research at CHRISTUS Spohn Health System, Corpus Christi, Texas. Stanley G. Cron is a research instructor and statistician and Deborah J. Jones is an assistant professor and assistant dean for undergraduate programs at University of Texas Health Science Center at Houston School of Nursing. Sandra A. Oldham is a professor of radiology at University of Texas Health Science Center at Houston Medical School. Sandra.K.Hanneman@uth.tmc.edu.
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Hanneman
authors.affiliation: Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research at University of Texas Health Science Center at Houston School of Nursing. Gary M. Gusick is a clinical nurse specialist in cardiovascular and transplant nursing at St Luke's Episcopal Hospital, Houston, Texas. Shannan K. Hamlin is program director of nursing research and evidence-based practice at Houston Methodist Texas Medical Center. Sheryln J. Wachtel is director of innovation and research at CHRISTUS Spohn Health System, Corpus Christi, Texas. Stanley G. Cron is a research instructor and statistician and Deborah J. Jones is an assistant professor and assistant dean for undergraduate programs at University of Texas Health Science Center at Houston School of Nursing. Sandra A. Oldham is a professor of radiology at University of Texas Health Science Center at Houston Medical School.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Gusick
authors.affiliation: Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research at University of Texas Health Science Center at Houston School of Nursing. Gary M. Gusick is a clinical nurse specialist in cardiovascular and transplant nursing at St Luke's Episcopal Hospital, Houston, Texas. Shannan K. Hamlin is program director of nursing research and evidence-based practice at Houston Methodist Texas Medical Center. Sheryln J. Wachtel is director of innovation and research at CHRISTUS Spohn Health System, Corpus Christi, Texas. Stanley G. Cron is a research instructor and statistician and Deborah J. Jones is an assistant professor and assistant dean for undergraduate programs at University of Texas Health Science Center at Houston School of Nursing. Sandra A. Oldham is a professor of radiology at University of Texas Health Science Center at Houston Medical School.
authors.forename: Shannan K
authors.initials: SK
authors.lastname: Hamlin
authors.affiliation: Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research at University of Texas Health Science Center at Houston School of Nursing. Gary M. Gusick is a clinical nurse specialist in cardiovascular and transplant nursing at St Luke's Episcopal Hospital, Houston, Texas. Shannan K. Hamlin is program director of nursing research and evidence-based practice at Houston Methodist Texas Medical Center. Sheryln J. Wachtel is director of innovation and research at CHRISTUS Spohn Health System, Corpus Christi, Texas. Stanley G. Cron is a research instructor and statistician and Deborah J. Jones is an assistant professor and assistant dean for undergraduate programs at University of Texas Health Science Center at Houston School of Nursing. Sandra A. Oldham is a professor of radiology at University of Texas Health Science Center at Houston Medical School.
authors.forename: Sheryln J
authors.initials: SJ
authors.lastname: Wachtel
authors.affiliation: Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research at University of Texas Health Science Center at Houston School of Nursing. Gary M. Gusick is a clinical nurse specialist in cardiovascular and transplant nursing at St Luke's Episcopal Hospital, Houston, Texas. Shannan K. Hamlin is program director of nursing research and evidence-based practice at Houston Methodist Texas Medical Center. Sheryln J. Wachtel is director of innovation and research at CHRISTUS Spohn Health System, Corpus Christi, Texas. Stanley G. Cron is a research instructor and statistician and Deborah J. Jones is an assistant professor and assistant dean for undergraduate programs at University of Texas Health Science Center at Houston School of Nursing. Sandra A. Oldham is a professor of radiology at University of Texas Health Science Center at Houston Medical School.
authors.forename: Stanley G
authors.initials: SG
authors.lastname: Cron
authors.affiliation: Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research at University of Texas Health Science Center at Houston School of Nursing. Gary M. Gusick is a clinical nurse specialist in cardiovascular and transplant nursing at St Luke's Episcopal Hospital, Houston, Texas. Shannan K. Hamlin is program director of nursing research and evidence-based practice at Houston Methodist Texas Medical Center. Sheryln J. Wachtel is director of innovation and research at CHRISTUS Spohn Health System, Corpus Christi, Texas. Stanley G. Cron is a research instructor and statistician and Deborah J. Jones is an assistant professor and assistant dean for undergraduate programs at University of Texas Health Science Center at Houston School of Nursing. Sandra A. Oldham is a professor of radiology at University of Texas Health Science Center at Houston Medical School.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Jones
authors.affiliation: Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research at University of Texas Health Science Center at Houston School of Nursing. Gary M. Gusick is a clinical nurse specialist in cardiovascular and transplant nursing at St Luke's Episcopal Hospital, Houston, Texas. Shannan K. Hamlin is program director of nursing research and evidence-based practice at Houston Methodist Texas Medical Center. Sheryln J. Wachtel is director of innovation and research at CHRISTUS Spohn Health System, Corpus Christi, Texas. Stanley G. Cron is a research instructor and statistician and Deborah J. Jones is an assistant professor and assistant dean for undergraduate programs at University of Texas Health Science Center at Houston School of Nursing. Sandra A. Oldham is a professor of radiology at University of Texas Health Science Center at Houston Medical School.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Oldham
mesh_terms: D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D010865:Pilot Projects; D012121:Respiration, Artificial / Q000009:adverse effects*; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control*