STUDY OBJECTIVES: We hypothesized that continuous, automatic turning utilizing a patient-friendly, low air loss surface would reduce the incidence of early ICU pneumonia in selected groups of critically ill medical patients. DESIGN: Prospective, randomized, controlled clinical trial. SETTING: Medical ICU of a large community teaching hospital. PATIENTS: One hundred twenty-four critically ill new admissions to the medical ICU at Charity Hospital in New Orleans. INTERVENTIONS: Patients were prospectively randomized within one of five diagnosis-related groups (DRG) -- sepsis (SEPSIS), obstructive airways disease (OAD), metabolic coma, drug overdose, and stroke -- to either routine turning on a standard ICU bed or to continuous turning on an oscillating air-flotation bed for a total of five days. MEASUREMENTS AND RESULTS: Patients were monitored daily during the treatment period for the development of pneumonia. The incidence of pneumonia during the first five ICU days was 22% in patients randomized to the standard ICU bed versus 9% for the oscillating bed (p = 0.05). This treatment effect was greatest in the SEPSIS DRG (23% versus 3%, p = 0.04). Continuous automatic oscillation did not significantly change the number of days of required mechanical ventilation, ICU stay, hospital stay, or hospital mortality overall or within any of the DRGs. CONCLUSIONS: We conclude that air-supported automated turning during the first five ICU days reduces the incidence of early ICU pneumonia in selected DRGs; however, this form of automated turning does not reduce other measured clinical outcome parameters.

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