Continuous lateral rotational therapy and systemic inflammatory response in posttraumatic acute lung injury: results from a prospective randomised study.

BACKGROUND: The incidence of posttraumatic acute lung injury is high and may result in increased mortality. Changes in the body position are additional measures to improve pulmonary gas exchange and to prevent pulmonary complications. We investigated the effect of a continuous lateral rotational therapy (CLRT) on the inflammatory response in patients with posttraumatic lung failure.

METHODS: After admission to the intensive care unit (ICU) and after randomisation, 13 patients were placed in a special motor-driven bed and CLRT was performed for 5 days. In the control group (n=14), patients were positioned conventionally. Samples from blood and from broncho-alveolar lavage fluid (BAL) were collected in both groups before study began and on day 5. The levels of cytokines (Tumour Necrosis Factor, Interleukin 6, Interleukin 8 or Intercellular Adhesion Molecule-1) were assessed and haemodynamic, pulmonary, and laboratory values were documented.

RESULTS: On day 5, no significant differences were found in cytokine levels between groups, but a significant decrease in IL-8 (p<0.01) and TNF-α (p<0.05) serum levels and an increase in IL-8 BAL levels was found in the CLRT-group, but not for conventionally managed patients. In general cytokine BAL levels tended to be increased in both groups, but more pronounced during CLRT. Daily assessment of the severity of disease (SAPS-II, SOFA) was significantly reduced in the study group on days 2-4 (p<0.05) in comparison to control group.

CONCLUSIONS: CLRT may attenuate the inflammatory response to posttraumatic acute lung injury. The exact mechanism of such an effect is unknown.