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BACKGROUND: This Population, Intervention, Comparison, and Outcomes-guided systematic review assesses continuous lateral rotation therapy versus conventional position changes in mechanically ventilated critically ill adults, evaluating mortality, ICU length of stay (LOS), and hospital LOS as primary outcomes and respiratory function, mechanical ventilation duration, pulmonary complications, and adverse events as secondary outcomes. METHODS: This systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (International Prospective Register of Systematic Reviews CRD42022384258). Searches spanned databases MEDLINE/PubMed, Embase, Scopus, ScienceDirect, Cochrane, CINAHL, and Web of Science, without language or publication year restrictions. Inclusion criteria involved randomized controlled trials (RCTs) and quasi-randomized trials, comparing continuous lateral rotation therapy (intervention) with conventional position changes (control). Risk of bias and quality of evidence for RCTs were assessed using the Cochrane Collaboration and Grading of Recommendations Assessment, Development, and Evaluation tools. For the quasi-randomized trials, the Risk of Bias in Non-Randomized Studies-of Interventions tool was used. RESULTS: In 18 studies with 1,466 participants (intervention, n = 700, 47.7%; control, n = 766, 52.2%), continuous lateral rotation therapy was predominantly used for prophylactic purposes, with protocols varying from 10-24 h/d. Meta-analysis (16 RCTs) favored continuous lateral rotation therapy for reduced mechanical ventilation duration (standardized mean difference [SMD] -0.17 [CI -0.29 to -0.04] d, P = .008) and lower nosocomial pneumonia incidence (odds ratio 0.39 [CI 0.29-0.52], P < .001). Continuous lateral rotation therapy showed no significant impact on mortality (odds ratio 1.04 [CI 0.80-1.34], P = .77), ICU LOS (SMD -0.11 [CI -0.25 to 0.02] d, P = .11), hospital LOS (SMD -0.10 [CI -0.31 to 0.11] d, P = .33), and incidence of pressure ulcers (odds ratio 0.73 [CI 0.34-1.60], P = .44). CONCLUSIONS: Continuous lateral rotation therapy showed no significant difference in primary outcomes (mortality, ICU and hospital LOS) but revealed significant differences in secondary outcomes (consistently reduced nosocomial pneumonia, with a minor effect on mechanical ventilation duration), supported by moderate certainty. Very low certainty for other outcomes highlights the need for current studies in diverse clinical settings and protocols to assess continuous lateral rotation therapy effectiveness. [ABSTRACT FROM AUTHOR]

Invasive ventilatory support and prolonged immobility in bed are predictive factors for the development of respiratory and musculoskeletal complications in critically ill patients, favoring increased length of hospital stay, morbidity and mortality, and costs associated with long hospital stays. To evaluate the impact of automatic rotational therapy on length of stay in the intensive care unit (ICU) in mechanically ventilated patients. Systematic review conducted from December to January 2023 with randomized clinical trials, following criteria reported in PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) registered in PROSPERO (CRD42022384258). The search strategy was built based on health sciences descriptors (DeCS), Medical Subject Headings (MeSH), keywords and synonyms most found in the literature. The search was carried out in seven databases: MEDLINE/PubMed, EMBASE, Scopus, Science Direct, Cochrane Library, CINAHL, and Web of Science. The eligibility criteria involved studies that evaluated automatic rotational therapy compared with changing the manual decubitus position during the length of stay in the ICU in individuals of both genders aged 18 years or older using invasive mechanical ventilation for a period. greater than 24 hours. There was no restriction on language or year of publication. The risk of bias was assessed using the Cochrane collaboration tool. 118 articles were identified, after excluding duplicates and reading in full, 9 were eligible, involving 679 participants. The number of individuals evaluated per article ranged from 27 to 124 in the control and intervention groups. For meta-analysis, four studies were included, totaling 323 participants. The standardized mean (SMD) difference was -0.03 days (95% CI -0.40, 0.35, p=0.90) between automatic rotational therapy and conventional recumbency, with no significant difference between groups with high evidence of overall heterogeneity (χ2 8.26, p= 0.04, I2 = 64%). Automatic rotational therapy did not have a significant impact on the length of stay in the ICU in mechanically ventilated critical patients. Therefore, it is not possible to make definitive recommendations on this therapy, reinforcing the need for new randomized clinical trials to better answer the research question. The development of this systematic review and meta-analysis enabled the expansion of knowledge about the possible benefits of automatic rotational therapy in critically ill patients, for future contributions to the scientific community and, due to the high heterogeneity between studies, it is shown as a field to be explored in future studies. [ABSTRACT FROM AUTHOR]