CLRT and Percussion/Vibration for Pulmonary Support
The typical patient needing pulmonary support is vented, sedated, and unable to cough or deep breathe on their
own. This may lead to additional complications, including higher risk for ARDS or pneumonia. Today’s ICU bed
frames and/or support surfaces can be valuable tools to encourage pulmonary hygiene.1
The key to avoiding pulmonary complications is to mobilize secretions—in other words, to move mucous that may
otherwise remain stagnant in the lungs and airways. Clinicians use three therapies to get things moving:
- Continuous Lateral Rotation Therapy (CLRT): using a specialized bed
frame or support surface, the patient is
turned side to side 40 degrees or more; gravity and movement mobilize secretions from the base of the lungs
to the point where they can be suctioned out2
- Percussion: repeated pounding on the chest breaks up sections. This can
be done through manual (with cupped
hands) or mechanical means (device integrated within the support surface)
- Vibration: often used in conjunction with percussion; helps move
secretions to the point where they can be
suctioned out. Can be done using a mechanical device integrated within the support surface or used by a
Which therapy and for how long?
The attending physician will typically prescribe therapy type, intensity, and duration. With rotational therapy
(CLRT), literature supports 60-90 minutes per side, rotating back and forth for a designated amount of time.
Nurses often track the number of hours within the past 24 hours that a patient was in rotation—the more the
Percussion and vibration may be prescribed individually, but are more often prescribed together— and in
conjunction with CLRT. Ideally, a patient will be on percussion/vibration for 30-45 minutes at a time and
perhaps up to 20 hours per day for the greatest effectiveness. Chest X-rays and other lung indicators are used
to track the patient’s progress.
Other CLRT considerations
Clinicians sometimes ask about the advantages of full-body vs. torso-only. Research shows full-body CLRT provides
the patient greater benefit by getting the legs activated and avoiding mobility complications such as
Another consideration: CLRT does not support pressure injury (PI) treatment or prevention. The NPUAP/NPIAP says
the small positioning shifts during CLRT do not replace proper repositioning or pressure
redistribution.4 ICU patients are already at elevated risk for PI, but sometimes that risk is
outweighed by the lifesaving benefits of CLRT.
Want more info?
The Sizewise Clinical Support Team is available to answer your questions or provide additional training.
Call 800-814-9389 or email email@example.com.