TotalCare SpO₂RT® Connect Pulmonary Therapy System

The Complications of Immobility

Complications of immobility such as nosocomial pneumonia are amongst the most commonly acquired infections in critical care ⁽¹⁾ with statistics showing affected patients have higher morbidity and mortality rates ⁽²⁾. However, the effects reach far beyond the patient, increasing caregiver workload with higher dependency rates, and exacerbating the financial burden on the hospital as the costs of caring for the patient rise with length of stay in both the critical care department and the hospital increasing. ⁽³⁾

Progressive Mobility™ Therapy programmes

For many years healthcare professionals have recognised the importance of positioning techniques particularly for the prevention of tissue damage. In more recent years however the concept of positioning has become more accepted as the potential impact becomes more deeply understood by the multidisciplinary team. In many situations repositioning a critically ill patient is challenging – in one study 49.5% of patients did not move during an 8-hour period. ⁽⁴⁾

However caregivers are increasingly recognising that with a Progressive Mobility™ Therapy programme health care facilities can reduce the incidence of nosocomial infections, reduce hospital length of stay and treatment costs.

Progressive Mobility™ Therapy refers to the concept of employing appropriate positioning techniques in order to:

The TotalCare® Connect family of products are the only specialised support systems available to day which can offer important mobilisation therapies necessary to assist your patient through increasing levels of mobility from Continuous Lateral Rotation Therapy to assisting them to standing:

Continuous Lateral Rotation Therapy

Preliminary tilt table

Sitting upright – from supine through 30° head of bed elevation to FullChair® position

Chair Egress™ position

TotalCare Sp0₂RT® Connect Pulmonary Therapy System - Key Features

New for TotalCare® Connect

With this latest version of the TotalCare Bed Hill-Rom have developed the most easy to use caregiver interface – a colour touch screen interface with improved graphical representation of key data. In one survey 90% of caregivers could immediately use the interface without additional training. On most versions of the new TotalCare Conenct frame the caregiver interface can be positioned on either side of the frame or on both sides.

In addition within the recording of data Hill-Rom have, at the request of our customers, enhanced the data collection by including the FullChair information and by providing a choice of settings for popular head of bed alarm.

Head of Bed Alarm and Trending

Many researchers have cited the importance of 30°-45° head of bed elevation in the prevention of ventilated associated pneumonia (VAP). In order to support VAP reduction protocols Hill-Rom introduced a unique 30° head of bed elevation alarm for the TotalCare ® family of products which alerts caregivers if the bed drops below 30° allowing caregivers to quickly respond. In the most recent version, TotalCare ® Connect Hill-Rom have further improved this unique alarm facility at the request of our customers to allow a choice to set the alarm at either 30° or 45°.Additionally, the Head Angle indicator can monitor how long (hours and minutes) the Head Angle is above 30º – for up to eight days – assisting hospitals to comply with VAP prevention protocols and guidelines.

FullChair® position

The FullChair® position optimises pulmonary efficiency and improves the patient’s psychological status especially in comparison to traditional Cardiac Chair positions. The FullChair® position, as provided by the TotalCare ® Connect family of products, meets the up in chair recommendations in the Progressive Mobility™ Therapy Guidelines for Critically Ill Patients ⁽⁵⁾. Achieved at the touch of a button Hill-Rom have built on their years of experience to design the next generation of FullChair® position incorporating a new Cradle Transition to provide a secure feeling and reduced migration to the foot end of the bed as they move into FullChair® position.

Chair Egress™ position

This simple mechanism facilitates earlier and safer mobilisation, enabling patients to achieve functional mobility sooner in the care process with reduced risk of injury to themselves and caregivers. Based on the patient’s condition, the patient has the option of side or foot end of bed egress. The next generation of TotalCare SpO₂RT ® Connect now has a Seat Deflate mechanism designed to be used in conjunction with the Chair Egress position or with a side egress option to provide a more stable and lower height platform from which to mobilise the patient.

Side Egress Option

Chair Egress™ Option

Continuous Lateral Rotation Therapy (CLRT)

At the heart of the system is the integrated Therapy-on-Demand® concept, which allows caregivers to easily commence treatment modalities such as continuous lateral rotation therapy (CLRT) when required. CLRT has been demonstrated to be effective in reducing the incidence of nosocomial pneumonia along with a reduction in ventilator days and length of stay in the ICU and hospital ^(6,7).

CLRT as delivered by the TotalCare SpO₂RT® Connect Pulmonary Therapy System combines Hill-Rom's unique integrated frame and surface design and patented method of rotation to provide safer and effective movement. This method of rotation offers significant advantages to both the patient and the caregiver.

Therapy settings (including depth and rate of rotation) can be customised by the caregiver to meet the needs of the individual patient at any time utilising the easy to use control system within the Graphical Caregiver Interface ®. Additionally the next generation of TotalCare SpO₂RT ® Connect now has 3 preset therapy options built into the GCI to provide more rapid therapy commencement if required.

Percussion and Vibration Therapies

Once again through the Therapy-on-Demand® concept a «Hands off»  option to aid in the mobilisation of pulmonary secretions when hands on therapy is contraindicated. Therapy settings (including intensity and speed of therapy) can be customised by the caregiver to meet the needs of the individual patient at any time utilising the easy to use control system within the Graphical Caregiver Interface ®. Additionally the next generation of TotalCare SpO₂RT ® now has 3 preset therapy options built into the GCI to provide more rapid therapy commencement if required.

Shearless Pivot® Patient Positioning

The unique mechanism combines the articulation of the frame and the integrated surface thereby minimising shear forces, reducing migration of the patient towards the foot of the bed. Repositioning is minimised and patient comfort maximised

FlexAfoot® Retractable Foot Mechanism

Caregivers can customise the overall length of the bed. The retracted footboard provides support to the patient’s feet, reducing the need for additional foot support devices. The overall surface can be retracted up to 12” (30.5 cm), which also aids the caregiver during transport in tight spaces.

Boost™ Feature

New for the TotalCare® Connect frame the Boost feature is designed to position the patient into the ideal position for repositioning – by putting the patient into a slight head down tilt and maximum inflating the mattress where possible.

Integrated Scale

The integrated scale option allows for easy-to-use, repeatable weighing accuracy with weight trending.

Turn Assist™ Feature

Facilitates easier patient handling with fewer staff to carry out routine patient care and helps reduce the risk of injury to caregiver and patients.

Management of Patient Skin Microclimate

Hill-Rom’s expertise in pressure ulcer management is built on millions of patient day’s experience, by listening directly to clinicians worldwide we continually enhance the performance of our surfaces as new technology becomes available .

In this latest development The TotalCare SpO₂RT® Connect Pulmonary Therapy System offers a unique double layer sleep surface which contains 4 separate zones fully integrated into the frame system, whose pressures are based on patient weight in order to optimise pressure redistribution. This unique design ensures pressure redistribution is maximised even during rotation therapy.

Additionally the next generation of TotalCare SpO₂RT ® Connect now has the option of Hill-Rom’s next generation Low Air Loss therapy using Airflow technology via the Therapy-on-Demand® concept.

At the skin interface point with the support surface, body heat becomes trapped causing the skin to rapidly warm. The extent to which heat is trapped in the surface determines the rate of heat accumulation and ultimately, its temperature. If skin temperature passes the “perspiration threshold”, sweating increases markedly. It has been show that this excess temperature and moisture build up negatively affect the microclimate of the skin, making it more susceptible to the damaging effects of pressure, shear and friction, decreasing the resilience of the epidermis to these external forces and making it more vulnerable to pressure ulcer development. For this reason the importance of limiting both skin warming and moisture accumulation are well recognised.

By providing a flow of air under the cover via an advanced technology spacer in combination with effective moisture vapour permeable (MVP) cover the withdrawal of perspiration and provides localised cooling of skin temperature is maximised in order to assist in the management of the patient skin microclimate.

Intellidrive ® Power Transport System with variable Speed Control

Mobility of the TotalCare® Connect Bed system during transfer can be greatly increased with the addition of the optional IntelliDrive® system. This feature also helps minimise the need to transfer patients to stretchers for transport. When transport is required, simply unplug the bed, release the brake, grip the handles and go.

With little effort, one caregiver can move even heavier patients on a carpeted surface; perform 180° turns with ease; navigate through obstacles, and achieve 90° turns with a hospital bed.

References

1. Vincent J.L., et al The Prevalence of nosocomial infection in intensive care units in Europe: Results of the European Prevalence of Infection in Intensive Care (EPIC) Study, JAMA 1995 274:8 639-644

2. Kappenstein I., et al Prolongation of hospital stay and extra costs due to ventilator associated pneumonia in an intensive care unit. Eur J Clin Microbiol Infect Dis 1992

3. CDC Guidelines for Prevention of Nosocomial Pneumonia 1997 MMWR 46(RR-1) 1-79

4. Krishnagopalan S. Body positioning of intensive care patients, clinical practice versus standards. Critical Care Medicine. 2002

5.Ahrens T., et al Progressive Mobility™ Therapy Guidelines for Critically Ill Patients. Advancing Nursing. 2005

6.Fink M.P., et al The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of trauma. Chest 1993 103 1543-1547

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