Background and Purpose: Traumatic spine injuries are an important cause of morbidity and
mortality. Kinetic therapy (KT) beds were designed to minimize skin breakdown and enhance
clearance of pulmonary secretions by rotating the patient from side to side. However, little
evidence exists to suggest that fewer complications occur in patients with thoracolumbar spine
injuries (TLSIs) treated preoperatively with a KT bed. We investigated the effect of KT bed
use on infectious complications and respiratory failure in patients requiring surgery for
TLSIs.
Methods: We queried the trauma registry of a Level 1 trauma center for patients who had
surgery for a TLSI from January 1, 1994, through June 30, 2001, and performed a retrospective
medical record review. Patients were divided into two groups according to whether they were
treated with a KT bed preoperatively. Patient data included age, injury severity score (ISS),
admission Glasgow Coma Scale score (GCS), time to surgery, narcotics administered in total
and during the first 24 h after injury, the lowest recorded systolic blood pressure, and acute
resuscitation volume requirement. Outcome data included infectious complications, neurologic
deficits, respiratory failure, hospital length of stay (LOS), and number of days of ventilator
support. Infectious complications included pneumonia, urinary tract infections, and
surgical site infections.
Results: Patients treated with a KT bed and patients treated with a conventional bed were
similar in age, ISS, admission GCS, time to surgery, total narcotics administered, lowest
recorded systolic blood pressure, and resuscitation requirement during the first 24 h. However,
patients with neurologic deficits were more frequently treated with a KT bed. Infectious
complications were more common in patients receiving KT bed therapy than among those on
conventional beds. The incidence of respiratory failure, the number of days of ventilator support,
and hospital LOS also were significantly higher in patients treated with KT beds. The
variables most predictive of infectious complications were the number of days of ventilator
support, the amount of fluid administered during the first 24 h, and KT bed therapy (r2 = 0.459).
Conclusions: Patients with TLSIs treated with a KT bed had a higher incidence of infectious
complications and respiratory failure and more days of ventilator support than patients treated with a conventional bed despite similar ISS and time to surgical repair. The longer
hospital LOS in patients treated with a KT bed may be secondary to the higher incidence of
infectious complications and respiratory failure and the greater number of days of ventilator
support.
