1.0 Hour C E N Notice to CNE enrollees: A closed-book, multiple-choice examination following this article tests your understanding of the following objectives: 1. Identify hemodynamic changes that occur with manual repositioning. 2. Discuss hemodynamic changes that occur with continuous rotation. 3. Determine if use of manual or automatic turning is safe for medical-surgical patients receiving mechanical ventilation. To read this article and take the CNE test online, visit www.ajcconline.org and click “CNE Articles in This Issue.” No CNE test fee for AACN members. By Shannan K. Hamlin, RN, PhD, ACNP-BC, AGACNP-BC, CCRN, Sandra K. Hanneman, RN, PhD, Nikhil S. Padhye, PhD, and Robert F. Lodato, MD, PhD Background Lateral turning of critical care patients receiving mechanical ventilation can adversely affect hemodynamic status. Objective To study hemodynamic responses to lateral turning. Method A time-series design with automated signal process- ing and ensemble averaging was used to evaluate changes in heart rate, mean arterial pressure, and pulse pressure due to lateral turning in 13 adult medical-surgical critical care patients receiving mechanical ventilation. Patients were randomly assigned to the manual-turn or the automated-turn protocol for up to 7 consecutive days. Heart rate and arterial pressure were measured every 6 seconds for more than 24 hours, and pulse pressure was computed. Results A total of 6 manual-turn patients and 7 automated-turn patients completed the study. Statistically significant changes in heart rate, mean arterial pressure, and pulse pressure occurred with the manual turn. Return of the hemodynamic variables to baseline values required up to 45 minutes in the manual-turn patients (expected recovery time ≤ 5 minutes). However, clinically important changes dissipated within 15 minutes of the lateral turn. The steady-state heart rate response on the right side was slightly greater (3 beats per minute) than that on the back (P = .003). Automated turning resulted in no clinically important changes in any of the 3 variables. Conclusions In medical-surgical critical care patients receiving mechanical ventilation, manual lateral turning was associated with changes in heart rate, mean arterial pressure, and pulse pressure that persisted up to 45 minutes. (American Journal of Critical Care. 2015;24:131-140) HEMODYNAMIC C HANGES WITH MANUAL AND AUTOMATED LATERAL TURNING IN PATIENTS RECEIVING MECHANICAL VENTILATION ©2015 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ajcc2015782 www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2015, Volume 24, No. 2 131 Pulmonary Critical Care Downloaded from http://aacnjournals.org/ajcconline/article-pdf/24/2/131/92531/131.pdf by guest on 27 November 2022