Another researcher discovered that the inpatient death rate for pressure ulcer positive patients ranges from 23% to 37%.(11)

When adjusted for life expectancy, functional status, and other complications, however, pressure ulcer formation is not an independent predictor of death.

Effective patient repositioning also benefits the pulmonary system. It aids in the prevention and treatment of pulmonary complications. Nosocomial infections complicate the recovery of hospitalized patients and exact a heavy toll in terms of mortality and healthcare dollars. In 1991, for example, they were directly linked to more than 80,000 deaths at a price tag that approached $10 billion by some estimates.(12-13)

About 20% of all nosocomial infections occur in critically ill patients and usually affect the respiratory system.(14-15) The prevalence of hospital-acquired pneumonia (HAP)—defined as a pneumonia occurring more than 48 hours after admission—is unknown, but current estimates suggest a rate as high as 10 cases per 1,000 admissions with a 20-fold increase for patients on mechanical ventilation. HAP has a mortality rate of 30%,
the highest of all nosocomial infections, and prolongs hospital stays by as much as seven to nine days per patient.(16)

Some specialty beds and surfaces deliver what is known as Kinetic Therapy. Kinetic Therapy is defined by the CDC as 40-degree rotation or greater to each side (an 80 degree arc) using a specialty bed.(17) Although the importance of movement in a patient's recovery has been known for years, recent scientific evidence has also shown a pulmonary benefit associated with rotational therapy greater than 40°.(18-23)

In 1998, Elsevier Science Ltd. published a study entitled: Is early kinetic positioning beneficial for pulmonary function in multiple trauma patients?
“Body positioning (kinetic therapy) is known to improve oxygenation in patients with impaired pulmonary function and ARDS. We have used body positioning prophylactically in trauma patients whose injury and pattern predispose to ARDS. The retrospective study reports the effects of early prophylactic axial rotation on pulmonary function and the incidence of ARDS. Both groups were comparable in age, injury severity and the degree of thoracic injury. Systemic oxygenation was significantly better and the incidence of ARDS significantly lower in group P (group P: 34.3 percent, group T: 74.1 percent, P<0.05). There was a tendency towards a lower incidence of pneumonia and a better survival in group P, which did not reach statistical significance. The duration of kinetic therapy and of ventilation was comparable in both groups. In this retrospective evaluation early prophylactic kinetic therapy was associated with a significantly lower incidence of ARDS compared with that instigated later.” (24)

“Body positioning is an inexpensive non-invasive method, which is known to improve oxygenation. The technique involves alternating prone and supine positioning or continuous axial rotation (kinetic therapy).” (24)

Many clinical studies have been conducted to research the clinical benefits of various degrees of rotation. These studies show that degree of rotation plays a critical role in the treatment and prevention of pulmonary complications. In the following clinical studies, while different degrees of rotation were delivered, statistically significant beneficial results for the treatment and prevention of pulmonary complications were seen only when 40 degrees or more of lateral rotation was administered.

McLean, B. Use of Progressive Lateral Rotation in Pulmonary Management of Refractory Hypoxemia.
Poster presented at January 1999 SCCM, San Francisco, California.
This randomized, prospective study compared the use of 45-degree Kinetic Therapy (90 degree arc) to conventional two hour turning. The study showed a 0% incidence of ARDS in the group receiving 45 degree Kinetic Therapy, while 50% of the group receiving conventional two hour turning developed ARDS.