The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

KINETIC THERAPY IMPROVES OXYGENATION IN CHILDREN

Theresa Ryan Schultz, RRT, RN, Richard Lin, MD, Mark A. Helfaer, MD. The Children's Hospital of Philadelphia, Pediatric Intensive Care Unit, Philadelphia, Pennsylvania 19104

BACKGROUND: Critically ill patients often suffer complications of immobility. Prolonged immobility can lead to pneumonia, increased morbidity, mortality and economic burden. Kinetic Therapy? (KT?) is a way to redistribute blood flow/lung gas volume in a way that matching of blood and gas will be enhanced. KT? reduces atelectasis, number of mechanical ventilation and ICU days compared with more traditional intermittent turning of critically ill adults1. To determine the effectiveness of KT? in children we have undertaken a prospective crossover design, block-randomized study. Children in the Intensive Care Unit weighing 15-60 pounds, requiring mechanical ventilation, who have arterial access and can safely be placed on a KCI PediDyne bed, are eligible for study.

Methods:
Informed consent is obtained for each enrolled patient. All patients receive both KT? and standard rotation and percussion (S), each for 12-18 hours prior to crossover. Arterial blood gases are done via I-Stat once every other hour for the study period (£3.6 cc blood per patient). Outcome variables monitored are Oxygenation Index (OI) PaO2/FiO2 (P/F), and A-a DO2.

Results:
Fourteen patients have been enrolled to date. Two patients exited protocol. Of the remaining twelve patients, seven received standard therapy first, five received KT? first. Based on the experience of our first study patient, the evaluation period was extended to 18 hours of each therapy.

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KINETIC THERAPY IMPROVES OXYGENATION IN CHILDREN

Pt. # 1st tx. OI after S OI after KT? P/F after S P/F after KT? A-aDO2 after S A-aDO2 after KT?
1 S 7.4 8.4 (12th hour) 5.1 (18th hour) 230 215 (12th hour) 331.3 (18th hour) 120.7 135.3 (12th hour) 80 (18th hour)
3 KT? 40 36.3 60 66.2 453.4 359.7
4 KT? 20 15.6 120 109.2 247.8 244.5
5 KT? 3.6 3.6 276.3 277.5 123.5 126.7
6 S 3.0 0 231.4 270 111 74.4
8 S 3.2 1.5 469 474 204 18.7
9 S 3.3 3.0 157.1 182.9 139.6 135.6
10 S 3.0 1.8 276.7 330 69.9 58.7
11 S 4.1 3.8 220 263.3 83.9 73.7
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