Dados do Trabalho

Título

Continuous lateral rotation in patients with acute respiratory failure: systematic analysis of pneumonia and mortality outcomes.

Objetivo

To compare the efficacy of continuous lateral rotation versus routine position changes in adults with respiratory failure, focusing on outcomes related to ventilator-associated pneumonia and mortality.

Métodos

Analysis of the main outcomes of this systematic review (PROSPERO: CRD42022384258) was conducted using the databases MEDLINE/PubMed, Embase, Scopus, ScienceDirect, Cochrane, CINAHL and Web of Science, with no restriction of language or publication date. Randomized or quasi-randomized clinical trials were included, with the risk of bias and quality of evidence assessed using the Cochrane Collaboration’s tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, as well as the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool, respectively.

Resultados

Mortality associated with continuous lateral rotation was investigated in 14 trials (n=1,267), revealing no significant impact (odds ratio 1.04 [CI 0.80–1.34], P < 5.77). The reduction of nosocomial pneumonia was analyzed in 11 studies (n=1,145) showing a favorable outcome for continuous lateral rotation (odds ratio 0.39 [CI 0.29–0.52], P < 0.001). Subgroup analysis based on indication for intervention, etiology, duration of treatment and degree of rotation did not influence mortality; however, continuous lateral rotation consistently demonstrated a lower risk ratio for pneumonia across all subgroups.

Conclusão

Continuous lateral rotation therapy did not reduce mortality but was significantly effective in preventing pneumonia, both overall and across all subgroups. Despite these favorable results, further studies are needed to confirm its superiority due to varying protocols and the moderate to very low levels of evidence in the included studies, especially considering emerging new positioning technologies.