Hemodynamic changes with manual and automated lateral turning in patients receiving mechanical ventilation.
BACKGROUND
Lateral turning of critical care patients receiving mechanical ventilation can adversely affect hemodynamic status.


OBJECTIVE
To study hemodynamic responses to lateral turning.


METHODS
A time-series design with automated signal processing and ensemble averaging was used to evaluate changes in heart rate, mean arterial pressure, and pulse pressure due to lateral turning in 13 adult medical-surgical critical care patients receiving mechanical ventilation. Patients were randomly assigned to the manual-turn or the automated-turn protocol for up to 7 consecutive days. Heart rate and arterial pressure were measured every 6 seconds for more than 24 hours, and pulse pressure was computed.


RESULTS
A total of 6 manual-turn patients and 7 automated-turn patients completed the study. Statistically significant changes in heart rate, mean arterial pressure, and pulse pressure occurred with the manual turn. Return of the hemodynamic variables to baseline values required up to 45 minutes in the manual-turn patients (expected recovery time ≤ 5 minutes). However, clinically important changes dissipated within 15 minutes of the lateral turn. The steady-state heart rate response on the right side was slightly greater (3 beats per minute) than that on the back (P = .003). Automated turning resulted in no clinically important changes in any of the 3 variables.


CONCLUSIONS
In medical-surgical critical care patients receiving mechanical ventilation, manual lateral turning was associated with changes in heart rate, mean arterial pressure, and pulse pressure that persisted up to 45 minutes.
Shannan K. Hamlin is director of the Department of Nursing Science, Houston Methodist Hospital and University of Texas Health Science Center at Houston School of Nursing, Houston, Texas. Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research and Nikhil S. Padhye is an associate professor of research, University of Texas Health Science Center at Houston School of Nursing. Robert F. Lodato is an associate professor in critical care medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health Science Center at Houston Medical School, Houston, Texas. SHamlin@HoustonMethodist.org.
Shannan K
SK
Hamlin
Shannan K. Hamlin is director of the Department of Nursing Science, Houston Methodist Hospital and University of Texas Health Science Center at Houston School of Nursing, Houston, Texas. Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research and Nikhil S. Padhye is an associate professor of research, University of Texas Health Science Center at Houston School of Nursing. Robert F. Lodato is an associate professor in critical care medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health Science Center at Houston Medical School, Houston, Texas.
Sandra K
SK
Hanneman
Shannan K. Hamlin is director of the Department of Nursing Science, Houston Methodist Hospital and University of Texas Health Science Center at Houston School of Nursing, Houston, Texas. Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research and Nikhil S. Padhye is an associate professor of research, University of Texas Health Science Center at Houston School of Nursing. Robert F. Lodato is an associate professor in critical care medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health Science Center at Houston Medical School, Houston, Texas.
Nikhil S
NS
Padhye
Shannan K. Hamlin is director of the Department of Nursing Science, Houston Methodist Hospital and University of Texas Health Science Center at Houston School of Nursing, Houston, Texas. Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research and Nikhil S. Padhye is an associate professor of research, University of Texas Health Science Center at Houston School of Nursing. Robert F. Lodato is an associate professor in critical care medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health Science Center at Houston Medical School, Houston, Texas.
Robert F
RF
Lodato
D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D010865:Pilot Projects; D011187:Posture / Q000502:physiology*; D012121:Respiration, Artificial; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors