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Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial
Abstract
Background Risk factors for nosocomial pneumonia, such as gastro-oesophageal reflux and subsequent aspiration, can be reduced by semirecumbent body position in intensive-care patients. The objective of this study was to assess whether the incidence of nosocomial pneumonia can also be reduced by this measure.Methods This trial was stopped after the planned interim analysis. 86 intubated and mechanically ventilated patients of one medical and one respiratory intensive-care unit at a tertiary-care university hospital were randomly assigned to semirecumbent (n=39) or supine (n=47) body position. The frequency of clinically suspected and microbiologically confirmed nosocomial pneumonia (clinical plus quantitative bacteriological criteria) was assessed in both groups. Body position was analysed together with known risk factors for nosocomial pneumonia.Findings The frequency of clinically suspected nosocomial pneumonia was lower in the semirecumbent group than in the supine group (three of 39 [8%] vs 16 of 47 [34%]; 95% CI for difference 10.0-42.0, p=0.003). This was also true for microbiologically confirmed pneumonia (semirecumbent 2/39 [5%] vs supine 11/47 [23%]; 4.2-31.8, p=0.018). Supine body position (odds ratio 6.8 [1.7-26.7], p=0.006) and enteral nutrition (5.7 [1.5-22.8], p=0.013) were independent risk factors for nosocomial pneumonia and the frequency was highest for patients receiving enteral nutrition in the supine body position (14/28, 50%). Mechanical ventilation for 7 days or more (10.9 [3.0-40.4], p=0.001) and a Glasgow coma scale score of less than 9 were additional risk factors.Interpretation The semirecumbent body position reduces frequency and risk of nosocomial pneumonia, especially in patients who receive enteral nutrition. The risk of nosocomial pneumonia is increased by long-duration mechanical ventilation and decreased consciousness.
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“Raising of the head of the patient’s bed decreases immigration to the lungs of gastric microbiota compared with supine positioning,149 but this practice also compromises microbial elimination from the lungs”
From The microbiome and critical illness (2016) · cites this paper as [149]
Citations
Cites
Controlled Sedation with Alphaxalone-Alphadolone
Ramsay, M. A. E., Savege, T. M., Simpson, B. R. J., & Goodwin, R. (1974) · BMJ · doi:10.1136/bmj.2.5920.656 · Cited by 2,860
The Prevalence of Nosocomial Infection in Intensive Care Units in Europe
Vincent, J. (1995) · JAMA · doi:10.1001/jama.274.8.639 · Cited by 2,592
The Risk of Determining Risk with Multivariable Models
Concato, J., Feinstein, A. R., & Holford, T. R. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-118-3-199302010-00009 · Cited by 1,129
Holtzman, D. J., Powell‐Griner, E., Bolen, J. C., & Rhodes, L. (2000) · PubMed · Cited by 1,110
Fagon, J.-Y., Chastre, J. E., Domart, Y., Trouillet, J., Pierre, J., Darne, C., & Gibert, C. (1989) · American Review of Respiratory Disease · doi:10.1164/ajrccm/139.4.877 · Cited by 819
Ventilator-Associated Pneumonia
Kollef, M. H. (1993) · JAMA · doi:10.1001/jama.270.16.1965 · Cited by 727
Cook, D., Guyatt, G. H., Marshall, J., Leasa, D. J., Fuller, H. D., Hall, R., Peters, S., Rutledge, F. S., Griffith, L. E., McLellan, A., et al. (1998) · New England Journal of Medicine · doi:10.1056/nejm199803193381203 · Cited by 726
Torres, A., Serra-Batlles, J., Ros, E., Piera, C., de la Bellacasa, J. P., Cobos, A., Lomeña, F., & Rodríguez-Roisin, R. (1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-116-7-540 · Cited by 721
Celis, R., Torres, A., Gatell, J. M., Almela, M., Rodriguez‐Roisin, R., & Agustí-Vidal, A. (1988) · CHEST Journal · doi:10.1378/chest.93.2.318 · Cited by 685
Guideline for Prevention of Nosocomial Pneumonia
Tablan, O. C., Anderson, L. J., Arden, N. H., Breiman, R. F., Butler, J. C., & McNeil, M. M. (1994) · Infection Control and Hospital Epidemiology · doi:10.1086/646989 · Cited by 578
Cited by
Sorted by citations
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J. E., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31827e83af · Cited by 9,694
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., Sevransky, J., Sprung, C. L., Douglas, I. S., Jaeschke, R., et al. (2013) · Intensive Care Medicine · doi:10.1007/s00134-012-2769-8 · Cited by 7,371
Dellinger, R. P., Levy, M. M., Carlet, J. M., Bion, J., Parker, M. M., Jaeschke, R., Reinhart, K., Angus, D. C., Brun‐Buisson, C., Beale, R. J., et al. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0934-2 · Cited by 6,789
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4683-6 · Cited by 6,621
“Rationale The semi-recumbent position has been demonstrated to decrease the incidence of VAP [425].”
BackgroundInfluential(2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200405-644st · Cited by 5,932
“pared with patients treated completely supine (143).”
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982
“018).(140,141) Optimizing oral health with chlorhexidine mouthwash twice daily was shown in 2 studies to reduce respiratory infection and nosocomial pneumonia in patients undergoing heart surgery.”
BackgroundSurviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002255 · Cited by 3,652
Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock
Dellinger, R. P., Carlet, J. M., Masur, H., Gerlach, H., Calandra, T., Cohen, J., Gea‐Banacloche, J., Keh, D., Marshall, J. C., Parker, M. M., et al. (2004) · Intensive Care Medicine · doi:10.1007/s00134-004-2210-z · Cited by 3,309
“The semi recumbent position has been demonstrated to decrease the incidence of ventilator-required pneumonia (77).”
BackgroundSurviving Sepsis Campaign guidelines for management of severe sepsis and septic shock
Dellinger, R. P., Carlet, J. M., Masur, H., Gerlach, H., Calandra, T., Cohen, J., Gea‐Banacloche, J., Keh, D., Marshall, J. C., Parker, M. M., et al. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000117317.18092.e4 · Cited by 3,038
Ventilator-associated Pneumonia
Chastre, J. E., & Fagon, J.-Y. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.165.7.2105078 · Cited by 2,884
“The same investigators then conducted a randomized trial comparing semirecumbent and supine positions (192).”
McClave, S. A., Martindale, R. G., Vanek, V. W., McCarthy, M., Roberts, P., Taylor, B., Ochoa, J. B., Napolitano, L., Cresci, G., the A.S.P.E.N. Board of Directors, et al. (2009) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607109335234 · Cited by 1,873
Aspiration Pneumonitis and Aspiration Pneumonia
Marik, P. E. (2001) · New England Journal of Medicine · doi:10.1056/nejm200103013440908 · Cited by 1,617
Alhazzani, W. A., Møller, M. H., Arabi, Y. M., Loeb, M. B., Gong, M. N., Fan, E., Oczkowski, S. J. W., Levy, M. M., Derde, L. P. G., Dzierba, A. L., et al. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004363 · Cited by 1,578
Malbrain, M. L. N. G., Cheatham, M. L., Kirkpatrick, A. W., Sugrue, M., Parr, M. J., Waele, J. J. D., Balogh, Z. J., Leppäniemi, A. K., Olvera, C., Ivatury, R. R., et al. (2006) · Intensive Care Medicine · doi:10.1007/s00134-006-0349-5 · Cited by 1,524
Taylor, B. E., McClave, S. A., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001525 · Cited by 1,476
“018).(140,141) Optimizing oral health with chlorhexidine mouthwash twice daily was shown in 2 studies to reduce respiratory infection and nosocomial pneumonia in patients undergoing heart surgery.”
BackgroundEpidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database
Rello, J., Ollendorf, D. A., Oster, G., Vera‐Llonch, M., Bellm, L. A., Redman, R. L., & Kollef, M. H. (2002) · CHEST Journal · doi:10.1378/chest.122.6.2115 · Cited by 1,303
Tablan, O. C., Anderson, L. J., Besser, R. E., Bridges, C. B., & Hajjeh, R. A. (2004) · PsycEXTRA Dataset · doi:10.1037/e548652006-001 · Cited by 1,295
Clinical and economic consequences of ventilator-associated pneumonia: A systematic review
Safdar, N., Dezfulian, C., Collard, H. R., & Saint, S. K. (2005) · Critical Care Medicine · doi:10.1097/01.ccm.0000181731.53912.d9 · Cited by 1,082
“Preventive strategy: selective digestive decontamination Wiener, 1995 (58) 48 hrs 31 8 (26) Clinical Medical-surgical ICU Winter, 1992 (59) 48 hrs 92 18 (20) Clinical and BAL Medical-surgical ICU Ferrer, 1994 (60) 72 hrs 41 10 (24) Clinical and PSB/BAL Respiratory ICU Pugin, 1991 (61) 48 hrs 27 21 (78) Clinical Surgic…”
The National Heart, L., Rice, T. W., Wheeler, A. P., Thompson, B. T., Steingrub, J., Hite, R. D., Moss, M., Morris, A., Dong, N., & Rock, P. (2012) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.2012.137 · Cited by 935
“Per usual intensive care unit (ICU) practice, patients were maintained in the semirecumbent position whenever possible.(18) Simplified versions of previous ARDS Network lung protective ventilation(19) and fluid-conservative hemodynamic management protocols(20) were used in all patients.”
Melsen, W. G., Rovers, M. M., Groenwold, R. H. H., Bergmans, D. C. J. J., Camus, C., Bauer, T. T., Hanisch, E. W., Klarin, B., Koeman, M., Krueger, W. A., et al. (2013) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(13)70081-1 · Cited by 856
Torres, A., Cillóniz, C., Niederman, M. S., Menéndez, R., Chalmers, J. D., Wunderink, R. G., & van der Poll, T. (2021) · Nature Reviews Disease Primers · doi:10.1038/s41572-021-00259-0 · Cited by 904
Cheatham, M. L., Malbrain, M. L. N. G., Kirkpatrick, A. W., Sugrue, M., Parr, M. J., Waele, J. J. D., Balogh, Z. J., Leppäniemi, A. K., Olvera, C., Ivatury, R. R., et al. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0592-4 · Cited by 760
“been emphasized to reduce the incidence of aspiration pneumonia [60, 61].”
BackgroundNosocomial infections in adult intensive-care units
Vincent, J. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13644-6 · Cited by 704
Resar, R. K., Pronovost, P. J., Haraden, C., Simmonds, T., Rainey, T. G., & Nolan, T. (2005) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(05)31031-2 · Cited by 633
Gramlich, L. M., Kichian, K., Pinilla, J. C., Rodych, N., Dhaliwal, R., & Heyland, D. K. (2004) · Nutrition · doi:10.1016/j.nut.2004.06.003 · Cited by 584
Early Noninvasive Ventilation Averts Extubation Failure in Patients at Risk
Ferrer, M., Valencia, M., Nicolás, J. M., Bernadich, Ó., Badia, J. R., & Torres, A. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200505-718oc · Cited by 567
Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia
Dodek, P., Keenan, S., Cook, D., Heyland, D. K., Jacka, M. J., Hand, L. E., Muscedere, J., Foster, D., Mehta, N., Hall, R., et al. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-4-200408170-00011 · Cited by 540
“On the basis of evidence from one level 2 trial (74), we conclude that semi-recumbent positioning (caring for patients positioned at 45 degrees from horizontal) is associated with decreased incidence of VAP.”
BackgroundVentilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention
Koenig, S. M., & Truwit, J. D. (2006) · Clinical Microbiology Reviews · doi:10.1128/cmr.00051-05 · Cited by 550
“found that the simple elevation of the head of bed to 45° results in dramatic reductions in VAP incidence and a trend toward reduced mortality (54).”
BackgroundDonovan, J., Little, P., Mills, N., Smith, M., Brindle, L., Jacoby, A., Peters, T., Frankel, S., Neal, D., & Hamdy, F. (2002) · BMJ · doi:10.1136/bmj.325.7367.766 · Cited by 533
ASPEN Safe Practices for Enteral Nutrition Therapy
Boullata, J. I., Carrera, A. L., Harvey, L. P., Escuro, A. A., Hudson, L. M., Mays, A., McGinnis, C., Wessel, J., Bajpai, S., Beebe, M. L., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607116673053 · Cited by 584
Enteral Omega-3 Fatty Acid, γ-Linolenic Acid, and Antioxidant Supplementation in Acute Lung Injury
Rice, T. W. (2011) · JAMA · doi:10.1001/jama.2011.1435 · Cited by 552
Prone Position in Acute Respiratory Distress Syndrome. Rationale, Indications, and Limits
Gattinoni, L., Taccone, P., Carlesso, E., & Marini, J. J. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201308-1532ci · Cited by 491
The microbiome and critical illness
Dickson, R. P. (2016) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00427-0 · Cited by 460
Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update
Klompas, M., Branson, R. D., Eichenwald, E. C., Greene, L. R., Howell, M. D., Lee, G. M., Magill, S. S., Maragakis, L. L., Priebe, G. P., Speck, K. A., et al. (2014) · Infection Control and Hospital Epidemiology · doi:10.1086/677144 · Cited by 444
“Of note, the larger of the 2 negative studies achieved minimal difference in head-of-bed elevation between the intervention and control groups, thereby limiting this study’s capacity to evaluate the effect of head-of-bed elevation on VAP or other outcomes.85 Nonetheless, a meta-analysis pooling these 3 studies did fin…”
Klompas, M., Branson, R. D., Cawcutt, K. A., Crist, M. B., Eichenwald, E. C., Greene, L. R., Lee, G. M., Maragakis, L. L., Powell, K. M., Priebe, G. P., et al. (2022) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2022.88 · Cited by 458
Ventilator-Associated Pneumonia
(2012) · Springer eBooks · doi:10.1007/springerreference_225126 · Cited by 406
Noninvasive Ventilation during Persistent Weaning Failure
Ferrer, M., Esquinas, A. M., Arancibia, F., Bauer, T. T., González, G., Carrillo, A., Rodriguez‐Roisin, R., & Torres, A. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200209-1074oc · Cited by 395
Brower, R. G. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181b6e30a · Cited by 387
“Furthermore, there are strong recommendations to elevate the head of the bed of critically ill patients to reduce risk of ventilator-acquired pneumonia from aspiration (52).”
BackgroundHarnessing the Power of Default Options to Improve Health Care
Halpern, S. D., Ubel, P. A., & Asch, D. A. (2007) · New England Journal of Medicine · doi:10.1056/nejmsb071595 · Cited by 370
van Nieuwenhoven, C. A., Vandenbroucke‐Grauls, C. M. J. E., van Tiel, F. H., Joore, H. C. A., van Schijndel, R. J. M. S., van der Tweel, I., Ramsay, G., & Bonten, M. J. M. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000198529.76602.5e · Cited by 367
“The effects of the semirecumbent position on the development of VAP, however, have been assessed in only one study (9).”
BackgroundResultInfluentialMetheny, N. A., Clouse, R. E., Chang, Y., Stewart, B. J., Oliver, D. A., & Kollef, M. H. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000206106.65220.59 · Cited by 365
“This finding likely has clinical significance and has been identified as a useful cut-point by other investigators (9, 21).”
ResultPrevention of hospital-associated pneumonia and ventilator-associated pneumonia
Kollef, M. H. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000128569.09113.fb · Cited by 356
“One randomized trial demonstrated a three-fold reduction in the incidence of VAP and a trend toward a reduced hospital mortality rate in patients treated in the semirecumbent position (maintained at 45°) compared with patients treated completely supine (78).”
ResultGI Complications in Patients Receiving Mechanical Ventilation
Mutlu, G. M., Mutlu, E., & Factor, P. H. (2001) · CHEST Journal · doi:10.1378/chest.119.4.1222 · Cited by 358
Why we should be wary of single-center trials
Bellomo, R., Warrillow, S. J., & Reade, M. C. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181bc7bd5 · Cited by 367
“In a single-center, randomized, controlled study of ventilator-associated pneumonia (1), placing patients in a semirecumbent position (45° vs.”
BackgroundDysphagia in acute stroke: incidence, burden and impact on clinical outcome
Arnold, M., Liesirova, K., Broeg-Morvay, A., Meisterernst, J., Schlager, M., Mono, M.-L., El-Koussy, M., Kägi, G., Jung, S., & Sarikaya, H. (2016) · PLOS ONE · doi:10.1371/journal.pone.0148424 · Cited by 398
Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals
Coffin, S. E., Klompas, M., Classen, D. C., Arias, K. M., Podgorny, K., Anderson, D. J., Burstin, H. R., Calfee, D. P., Dubberke, E. R., Fraser, V. J., et al. (2008) · Infection Control and Hospital Epidemiology · doi:10.1086/591062 · Cited by 337
“Maintain patients in a semirecumbent position (30 -45 elevation of the head of the bed) unless there are contraindications.(28,50,52,53,57,65,72-76) (a) Experimental trials have demonstrated that backrest elevation is associated with a reduced risk of pulmonary aspiration.”
BackgroundVentilator-associated pneumonia
Members of the Task Force:, Bouza, E., Brun‐Buisson, C., Chastre, J. E., Ewig, S., Fagon, J.-Y., Marquette, C., Muñóz, P., Niederman, M. S., Papazian, L., et al. (2001) · European Respiratory Journal · doi:10.1183/09031936.01.17510340 · Cited by 337
“Moreover, the effect of semi-recumbent position on a reduction of VAP has been demonstrated [70].”
Improving patient safety in intensive care units in Michigan
Pronovost, P. J., Berenholtz, S. M., Goeschel, C. A., Thom, I., Watson, S. R., Holzmueller, C. G., Lyon, J. S., Lubomski, L. H., Thompson, D. A., Needham, D. M., et al. (2008) · Journal of Critical Care · doi:10.1016/j.jcrc.2007.09.002 · Cited by 330
“The ventilator bundle included 5 practices known to decrease morbidity, mortality, or duration of ventilator support that are associated with mechanical ventilation [31]: (1) elevate the head of the bed to at least 30°; (2) provide appropriate sedation—patient able to follow simple commands [32]; (3) provide appropria…”
BackgroundMasterton, R. G., Galloway, A., French, G. L., Street, M. K., Armstrong, J., Brown, E. A., Cleverley, J., Dilworth, P., Fry, C., Gascoigne, A. D., et al. (2008) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkn162 · Cited by 321
Heyland, D. K., Drover, J., MacDonald, S., Novak, F. J., & Lam, M. (2001) · Critical Care Medicine · doi:10.1097/00003246-200108000-00001 · Cited by 312
“Furthermore, in a randomized trial of mechanically ventilated patients, elevating the head of the bed to 45° was associated with a significant reduction in pneumonia (both clinically and bronchoscopically diagnosed) compared with for patients treated in the supine position (31).”
ResultVentilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients
Foglia, E. E., Meier, M. D., & Elward, A. M. (2007) · Clinical Microbiology Reviews · doi:10.1128/cmr.00041-06 · Cited by 314
Muscedere, J., Rewa, O., Mckechnie, K., Jiang, X., Laporta, D., & Heyland, D. K. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e318218a4d9 · Cited by 311
“Strategies that aim to reduce the quantity of bacteria aspirated are semirecumbency positioning (32) and those that reduce the inoculums of bacteria in aspirated secretions, such as decontamination of the oral cavity with chlorhexidine (33) or selective decontamination of the digestive tract (34).”
BackgroundAspiration pneumonia: A review of modern trends
DiBardino, D. M., & Wunderink, R. G. (2014) · Journal of Critical Care · doi:10.1016/j.jcrc.2014.07.011 · Cited by 304
“Aspiration rates not only were higher in patients who were supine but were dependent on how much time was spent in the supine position [127].”
BackgroundPrevention of Ventilator-Associated Pneumonia: An Evidence-Based Systematic Review
Collard, H. R., Saint, S. K., & Matthay, M. A. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-6-200303180-00015 · Cited by 300
“The third trial found a statistically significant reduction in ventilatorassociated pneumonia (14).”
BackgroundInfluentialDefining, treating and preventing hospital acquired pneumonia: European perspective
Torres, A., Ewig, S., Lode, H., Carlet, J. M., & For The European HAP working group (2008) · Intensive Care Medicine · doi:10.1007/s00134-008-1336-9 · Cited by 301
“Recently, a large body of evidence has shown that patient positioning is crucial in the development of VAP [181, 182].”
BackgroundEffect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia*
Zack, J. E., Garrison, T., Trovillion, E., Clinkscale, D., Coopersmith, C. M., Fraser, V. J., & Kollef, M. H. (2002) · Critical Care Medicine · doi:10.1097/00003246-200211000-00001 · Cited by 297
“These studies suggest that prevention of this nosocomial infection could improve patient outcomes as also suggested by studies of specific interventions aimed at avoiding risk factors associated with ventilator-associated pneumonia (29, 30).”
BackgroundHeyland, D., Schroter‐Noppe, D., Drover, J., Jain, M., Keefe, L., Dhaliwal, R., & Day, A. G. (2003) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/014860710302700174 · Cited by 297
Mechanical Ventilator Weaning Protocols Driven by Nonphysician Health-Care Professionals
Ely, E. W., Meade, M. O., Haponik, E. F., Kollef, M. H., Cook, D. J., Guyatt, G. H., & Stoller, J. K. (2001) · CHEST Journal · doi:10.1378/chest.120.6_suppl.454s · Cited by 288
Muscedere, J., Dodek, P., Keenan, S., Fowler, R. A., Cook, D., & Heyland, D. K. (2008) · Journal of Critical Care · doi:10.1016/j.jcrc.2007.11.014 · Cited by 288
“Semirecumbent positioning On the basis of 1 level 1 [82] and 1 level 2 trial [83], we conclude that semirecumbent positioning may be associated with a decreased incidence of VAP.”
BackgroundGive your patient a fast hug (at least) once a day*
Vincent, J. (2005) · Critical Care Medicine · doi:10.1097/01.ccm.0000165962.16682.46 · Cited by 281
“Several studies have demonstrated that having the head of the bed inclined at 45 degrees can decrease the incidence of gastroesophageal reflux in mechanically ventilated patients (43, 44), and one randomized, controlled study demonstrated reduced rates of nosocomial pneumonia when patients were nursed semirecumbent (4…”
BackgroundRotstein, C., Evans, G. A., Born, A., Grossman, R. F., Light, R. B., Magder, S. A., McTaggart, B., Weiss, K., & Zhanel, G. G. (2007) · Canadian Journal of Infectious Diseases and Medical Microbiology · doi:10.1155/2008/593289 · Cited by 283
“9) and Glasgow Coma Scale scores of less than 9 (128).”
BackgroundBarbier, F., Andremont, A., Wolff, M., & Bouadma, L. (2013) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0b013e32835f27be · Cited by 281
Barriers to providing lung-protective ventilation to patients with acute lung injury
Rubenfeld, G. D., Cooper, C., Carter, G. L., Thompson, B., & Hudson, L. D. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000127266.39560.96 · Cited by 273
Shander, A., Fleisher, L. A., Barie, P. S., Bigatello, L. M., Sladen, R. N., & Watson, C. B. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e31821f0522 · Cited by 272
“It may also decrease the incidence of VAP (110).”
BackgroundJain, M. (2006) · BMJ Quality & Safety · doi:10.1136/qshc.2005.016576 · Cited by 270
ICU-Acquired Swallowing Disorders
Macht, M., Wimbish, T., Bodine, C., & Moss, M. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31829caf33 · Cited by 260
“Additionally, supine bed position and frequent gastroesophageal reflux in mechanically ventilated patients have been demonstrated to increase the risk for nosocomial pneumonia (62, 74, 75).”
BackgroundVentilator associated pneumonia
Hunter, J. D. (2012) · BMJ · doi:10.1136/bmj.e3325 · Cited by 260
Plotting basic control charts: tutorial notes for healthcare practitioners
Mohammed, M. A., Worthington, P. L., & Woodall, W. H. (2008) · BMJ Quality & Safety · doi:10.1136/qshc.2004.012047 · Cited by 242
Risk Factors for Ventilator‐Associated Pneumonia: From Epidemiology to Patient Management
Bonten, M. J. M., Kollef, M. H., & Hall, J. B. (2004) · Clinical Infectious Diseases · doi:10.1086/383039 · Cited by 238
“with patients who were treated while completely supine [31].”
BackgroundChest physiotherapy for the prevention of ventilator-associated pneumonia
Ntoumenopoulos, G., Presneill, J., McElholum, M., & Cade, J. F. (2002) · Intensive Care Medicine · doi:10.1007/s00134-002-1342-2 · Cited by 234
“Many risk factors have been associated with VAP, including the presence of chronic obstructive airway disease, airway intubation, reduced conscious state, intracranial pressure monitoring, airway re-intubation, mechanical ventilation greater than 7 days, use of positive end-expiratory pressure, and supine patient posi…”
BackgroundInfluentialReducing ventilator-associated pneumonia in intensive care: Impact of implementing a care bundle*
Morris, A. C., Hay, A. W., Swann, D. G., Everingham, K., McCulloch, C., McNulty, J., Brooks, O., Laurenson, I. F., Cook, B., & Walsh, T. S. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182227d52 · Cited by 232
“Several clinical interventions have been found to reduce the incidence of VAP, including elevation of the head of the bed (4, 5), a daily sedation break (6), a daily trial of ventilator weaning (7, 8), and topical oral chlorhexidine (9).”
BackgroundAn Educational Intervention to Reduce Ventilator-Associated Pneumonia in an Integrated Health System
Babcock, H. M., Zack, J. E., Garrison, T., Trovillion, E., Jones, M., Fraser, V. J., & Kollef, M. H. (2004) · CHEST Journal · doi:10.1378/chest.125.6.2224 · Cited by 227
Oral Care Reduces Incidence of Ventilator-Associated Pneumonia in ICU Populations
Mori, H., Hirasawa, H., Oda, S., Shiga, H., Matsuda, K., & Nakamura, M. (2005) · Intensive Care Medicine · doi:10.1007/s00134-005-0014-4 · Cited by 225
“Although the methods used for patient management in the present study were basically unchanged during the 8-year study period, some of the various methods for VAP prevention published during that period (semi-recumbent patient positioning, use of an endotracheal tube with a suction port for subglottic secretion draina…”
MethodMelsen, W. G., Rovers, M. M., Koeman, M., & Bonten, M. J. M. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182281f33 · Cited by 210
Wafaisade, A., Lefering, R. L., Bouillon, B., Sakka, S. G., Thamm, O. C., Paffrath, T., Neugebauer, E. A. M., & Maegele, M. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e318206d3df · Cited by 213
“, with respect to mechanical ventilation (21, 22) and weaning (23, 24).”
BackgroundEdsberg, L. E., Langemo, D. K., Baharestani, M. M., Posthauer, M. E., & Goldberg, M. (2014) · Journal of Wound Ostomy and Continence Nursing · doi:10.1097/won.0000000000000050 · Cited by 203
Insights into Severe Sepsis in Older Patients: From Epidemiology to Evidence-Based Management
Girard, T. D., Opal, S. M., & Ely, E. W. (2005) · Clinical Infectious Diseases · doi:10.1086/427876 · Cited by 202
“the risk of ventilator-associated pneumonia (grade C) [50].”
BackgroundValencia, M., Ferrer, M., Farré, R., Navajas, D., Badia, J. R., Nicolás, J. M., & Torres, A. (2007) · Critical Care Medicine · doi:10.1097/01.ccm.0000266686.95843.7d · Cited by 196
“97 Chronic alcohol abuse (current or former), n (%) 11 (15) 10 (15) .”
BackgroundInfluentialStrategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update
Klompas, M., Branson, R. D., Eichenwald, E. C., Greene, L. R., Howell, M. D., Lee, G. M., Magill, S. S., Maragakis, L. L., Priebe, G. P., Speck, K. A., et al. (2014) · Infection Control and Hospital Epidemiology · doi:10.1017/s0899823x00193894 · Cited by 196
“Elevating the head of the bed has been evaluated in only 3 randomized controlled trials enrolling 337 patients altogether.(84)"(86) One trial reported a 76% decrease in VAP rates, whereas the other 2 found no difference in VAP rates.”
Heyland, D. K., Drover, J., Dhaliwal, R., & Greenwood, J. K. (2002) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/014860710202600608 · Cited by 185
Mechanical Ventilation in ARDS
Girard, T. D., & Bernard, G. R. (2007) · CHEST Journal · doi:10.1378/chest.06-1515 · Cited by 182
Booth, C. M., Heyland, D. K., & Paterson, W. G. (2002) · Critical Care Medicine · doi:10.1097/00003246-200207000-00005 · Cited by 180
“Strategies that can reduce the amount of duodenogastric reflux, gastric colonization, gastroesophageal regurgitation, and pulmonary aspiration, such as raising the head of the bed, have the potential for reducing the burden of illness associated with nosocomial pneumonia (68).”
BackgroundManzano, F., Fernández‐Mondejar, E., Colmenero, M., Poyatos, M. E., Rivera-Fernández, R., Machado, J., Catalán, I., & Artigas, A. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e31817b8a92 · Cited by 179
“Other authors reported that a simple and effective maneuver to reduce pneumonia incidence, such as oral decontamination or semirecumbent position, had no effect on the length of time on mechanical ventilation or in the ICU (33, 34).”
BackgroundInfluentialO’Brien, J. M., Ali, N. A., Aberegg, S. K., & Abraham, E. H. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2007.01.035 · Cited by 192
Recommendations for sepsis management in resource-limited settings
Dünser, M. W., Festic, E., Dondorp, A., Kissoon, N., Ganbat, T., Kwizera, A., Haniffa, R., Baker, T., Schultz, M. J., & Global Intensive Care Working Group of the European Society of Intensive Care Medicine (2012) · Intensive Care Medicine · doi:10.1007/s00134-012-2468-5 · Cited by 176
“acquired pneumonia, particularly when mental state is impaired or enteral nutrition administered [51, 52].”
BackgroundDysphagia: Foundation, theory and practice
Cichero, J. A. Y., & Murdoch, B. E. (2006) · Cited by 175
Management of pneumonia in critically ill patients
Cillóniz, C., Torres, A., & Niederman, M. S. (2021) · BMJ · doi:10.1136/bmj-2021-065871 · Cited by 198
Associations Between Ventilator Bundle Components and Outcomes
Klompas, M., Li, L., KLEINMAN, K. P., Szumita, P. M., & Massaro, A. F. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.2427 · Cited by 170
Wang, L., Li, X., Yang, Z., Tang, X., Yuan, Q., Deng, L., & Sun, X. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009946.pub2 · Cited by 166
Evidence on measures for the prevention of ventilator-associated pneumonia
Lorente, L., Blot, S. I., & Rello, J. (2007) · European Respiratory Journal · doi:10.1183/09031936.00048507 · Cited by 165
Catastrophic Antiphospholipid Syndrome
Vora, S. K., Asherson, R. A., & Erkan, D. (2006) · Journal of Intensive Care Medicine · doi:10.1177/0885066606287041 · Cited by 165
“Mechanically ventilated patients with CAPS should be positioned with the head of the bed at 45° to reduce the incidence of ventilator-associated pneumonia [60].”
Outcomes associated with enteral tube feedings in a medical intensive care unit.
Elpern, E., Stutz, L., Peterson, S., Gurka, D., & Skipper, A. (2004) · American Journal of Critical Care · doi:10.4037/ajcc2004.13.3.221 · Cited by 180
“Although aspiration increased when patients were supine, the length of time a patient was kept in this position was critical in determining risk.(17)”
BackgroundBundles to prevent ventilator-associated pneumonia: how valuable are they?
Wip, C., & Napolitano, L. M. (2009) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0b013e3283295e7b · Cited by 159
Toward understanding evidence uptake: Semirecumbency for pneumonia prevention
Cook, D. J., Meade, M. O., Hand, L. E., & McMullin, J. P. (2002) · Critical Care Medicine · doi:10.1097/00003246-200207000-00012 · Cited by 159
“A recent randomized trial showed that mechanically ventilated patients cared for in the semirecumbent position had lower rates of clinically suspected and microbiologically confirmed pneumonia than patients in the supine position (9).”
BackgroundVentilator-Associated Pneumonia: A Review
Davis, K. A. (2006) · Journal of Intensive Care Medicine · doi:10.1177/0885066606288837 · Cited by 154
Ventilator Associated Pneumonia: Evolving Definitions and Preventive Strategies
Mietto, C., Pinciroli, R., Patel, N. G., & Berra, L. M. (2013) · Respiratory Care · doi:10.4187/respcare.02380 · Cited by 162
“Am J Respir Crit Care Med 1996;154(1):111-115.”
Pathophysiology of the systemic inflammatory response after major accidental trauma
Brøchner, A. C., & Toft, P. (2009) · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine · doi:10.1186/1757-7241-17-43 · Cited by 159
“The benefit of postponing reconstructive surgery therefore has to be balanced against these risks [62,63].”
Strategies for Prevention of Health Care–Associated Infections in the NICU
Polin, R. A., Denson, S. E., Brady, M. T., Papile, L. A., Baley, J. E., Carlo, W. A., Cummings, J. J., Kumar, P., Tan, R. C., Watterberg, K. L., et al. (2012) · PEDIATRICS · doi:10.1542/peds.2012-0145 · Cited by 154
Oral Care Practices for Orally Intubated Critically Ill Adults
Feider, L. L., Mitchell, P. H., & Bridges, E. J. (2010) · American Journal of Critical Care · doi:10.4037/ajcc2010816 · Cited by 154
Metadata
- Authors
- Drakulovic, M. B., Torres, A., Bauer, T. T., Nicolas, J. M., Nogué, S., & Ferrer, M.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1999-11
- Volume
- 354
- Issue
- 9193
- Pages
- 1851-1858
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2143385226
- Cited by
- 1,243
- References
- 37
- Citations by year
- 2026: 15 · 2025: 13 · 2024: 19 · 2023: 19 · 2022: 22 · 2021: 20 · 2020: 19 · 2019: 20 · 2018: 25 · 2017: 44 · 2016: 40 · 2015: 50 · 2014: 60 · 2013: 58 · 2012: 61
- FWCI
- 31.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- nosocomial pneumonia, semi-recumbent position, mechanical ventilation, intensive care unit patients, enteral nutrition, risk factors, mechanical ventilation duration, Glasgow Coma Scale
- MeSH terms
- Aged, Analysis of Variance, Cross Infection, Enteral Nutrition, Female, Humans, Intensive Care Units, Male, Middle Aged, Pneumonia, Aspiration, Posture, Respiration, Artificial, Risk Factors, Spain, Time Factors, Incidence, Logistic Models, Odds Ratio, Supine Position, Hospital Mortality
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