• David R Goldhill, Michael Imhoff, Barbara McLean, and Carl Waldmann.
• The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. david.goldhill@rnoh.nhs.uk
• Am. J. Crit. Care. 2007 Jan 1; 16 (1): 50-61; quiz 62.

BackgroundImmobility is associated with complications involving many body systems.ObjectiveTo review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients.MethodsPublished articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses.ResultsA literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality.ConclusionsRotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.

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