• Shannan K Hamlin, Sandra K Hanneman, Nikhil S Padhye, and Robert F Lodato.
• 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.
• Am. J. Crit. Care. 2015 Mar 1;24(2):131-40.

BackgroundLateral turning of critical care patients receiving mechanical ventilation can adversely affect hemodynamic status.ObjectiveTo study hemodynamic responses to lateral turning.MethodA 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.ResultsA 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.ConclusionsIn 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.©2015 American Association of Critical-Care Nurses.

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