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From March 1986 through November 1987, 106 blunt trauma patients were randomized to receive either a conventional hospital bed or the RRKTT. Seven patients who were in the SICU for <24 h were excluded from the analyses. Another 13 patients were randomized to the study group, but were either never put on the oscillating bed or were taken off the RRKTT prematurely (ie, prior to discharge from the SICU). During the initial few months of the study, several patients with lower extremity injuries requiring traction were randomized to the oscillating bed group, but were not placed on the RRKTT because of objections raised by attending orthopedic surgeons. As institutional familiarity with the bed increased, this problem resolved. During the entire course of the study, several patients spent one or more days on the study bed, but because of problems encountered were later switched to a conventional bed while still in the RRKTT group in the SICU. These problems included: compression of unstable facial fractures (particularly those involving the zygomatic arch); concerns about the effect of the bed on intracranial pressure; and patient intolerance of the beds rotation and confining aspects. Most patients were rotated 40° bilaterally for 10 to 16 h per day.

Table 1 is a summary of the clinical characteristics for the two groups of patients entered into the trial. The study and control patients were similar in terms of age, sex ratio, injury severity and degree of physiological derangement. There were more patients with major head trauma randomized to the conventional bed group; this difference approached but did not achieve statistical significance (p = 0.0639).
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Table 1—Clinical Characteristics of Study Groups

Lower respiratory tract infection and pneumonia (while in the SICU) occurred significantly less often among patients randomized to the RRKTT (Table 2). There were fewer patients with head trauma in the RRKTT group, however, and head trauma and pres-ence of an intracranial pressure monitor are known risk factors for nosocomial pneumonia. Therefore, we analyzed the data separating patients into “head trauma” and “no head trauma” subgroups. In these two subgroups, LRTI tended to occur less often in RRKTT treatment arm, although statistical signifi-cance was not achieved. The incidence of pneumonia was significantly reduced by the RRKTT in head trauma victims, but the effect of the rotating bed was much less evident in patients without head trauma.

As noted previously, 13 patients were randomized to the RRKTT group but either were never placed on the oscillating bed or were taken off it prematurely (ie, prior to discharge from the SICU). In general, we analyzed our results by including these 13 patients in the RRKTT group (iie, we used an “intention-to-treat” analysis). However, we also analyzed our data deleting these patients from the RRKTT group. The results obtained by this analysis were similar to those pre¬sented previously. There were 31 patients in the “censored” RRKTT group; 11 of these (35.5 percent) met criteria for LRTI (p = 0.0089 vs conventional bed group) and 5 (16.1 percent) met criteria for pneumonia (p = 0.0079 vs conventional bed group).
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Related Posts:

• The Efficacy of an Oscillating Bed in the Prevention of Lower Respiratory Tract Infection: DISCUSSION part 2
• The Efficacy of an Oscillating Bed in the Prevention of Lower Respiratory Tract Infection: DISCUSSION
• The Efficacy of an Oscillating Bed in the Prevention of Lower Respiratory Tract Infection: RESULTS part 2
• The Efficacy of an Oscillating Bed in the Prevention of Lower Respiratory Tract Infection: METHODS