Cited by 1,243Nosocomial Infections in ICUIntensive Care Unit Cognitive DisordersRespiratory Support and Mechanisms

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Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial

Drakulovic, Mitra B, Torres, Antoni, Bauer, Torsten T, Nicolas, Jose M, Nogué, Santiago, Ferrer, Miquel·1999·The Lancet

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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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Zincircioğlu, Ç., Yaman, G., Köse, I., Albayrak, M. Z., Uzun, U., Sarıtaş, A., & Şenoğlu, N. (2020) · The Anatolian Journal of General Medical Research · doi:10.5222/terh.2020.99810 · Cited by 1
Ventilator-Associated Pneumonia
Chastre, J. E., & Luyt, C. E. (2015) · Elsevier eBooks · doi:10.1016/b978-1-4557-3383-5.00034-8 · Cited by 1
Critical Care of Postoperative Patient after Major Onco-Surgery: Overview
Gupta, N., Vig, S., & Gupta, A. (2021) · Springer eBooks · doi:10.1007/978-981-15-7699-7_16 · Cited by 1
¿Realizamos las medidas no farmacológicas para prevenir la neumonía asociada a la ventilación mecánica?
Heberling, T., Canale, D., Crosio, M., Valle, A. D., Petraroia, G., Tolay, H., kuszczak, M., Cognigni, L., Moracci, R. S., Vera, T., et al. (2021) · Argentinian Journal of Respiratory & Physical Therapy · doi:10.58172/ajrpt.v3i1.122 · Cited by 1
Rotinas de Unidades de Terapia Intensiva
Ghiggi, K. C., & Almeida, G. B. (2021) · VITTALLE - Revista de Ciências da Saúde · doi:10.14295/vittalle.v33i1.13255 · Cited by 1
INTERNISTISCHE INTENSIVMEDIZIN
Jung, N., Mayet, W.-J., Mertens, P. R., Meyer, J., Müller, O.-A., Pfeifer, M., Schellinger, P. D., Weiss, N., & Wendtner, C.-M. (2020) · Elsevier eBooks · doi:10.1016/b978-3-437-06282-7.50017-6 · Cited by 1
Factores de riesgo y coste económico de la infección nosocomial en un hospital de ámbito comarcal
Hernández, H., & Alberto, J. (2001) · TDX (Tesis Doctorals en Xarxa) · Cited by 1
Evidence-Based Medicine in the Intensive Care Unit
Petros, A., Lowry, K. G., van Saene, H. K. F., & Marshall, J. C. (2005) · Springer eBooks · doi:10.1007/88-470-0361-x_30 · Cited by 1
“The intervention of sub-glottic drainage has been evaluated in four RCTs [18–21] (Table 3).”
BackgroundInfluential
Prévention des pneumopathies acquises sous ventilation mécaniquePrevention of hospital-acquired pneumonia during mechanical ventilation.
Fagon, J.-Y., Ract, C., & Novara, A. (2001) · Réanimation · doi:10.1016/s1164-6756(00)00088-8 · Cited by 2
The Integration of Evidence Based Medicine and Health Services Research in the ICU
Cook, D. J., & Giacomini, M. K. (2002) · Springer eBooks · doi:10.1007/978-1-4615-6939-8_13 · Cited by 1
Ventilator-associated pneumonia: approaching the horizon
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Minimizing Pulmonary Complications during the Perioperative Period
Hata, J. S. (2004) · ASA Refresher Courses in Anesthesiology · doi:10.1097/00126869-200432010-00010 · Cited by 1
La ventilation non-invasive au decours de l'intubation
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Preventing ventilator-associated pneumonia: is it ultimately only a matter of gravity?
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“Surprisingly, data supporting the effectiveness of the semirecumbent position are relatively few and conflicting, resulting only from three, rather small, randomized controlled trials [7–9].”
Background
Aktuelle Konzepte der Intensivtherapie des raumfordernden Mediainfarkts
Schwarz, S., Georgiadis, D., Schwab, S., Aschoff, A., & Hacke, W. (2002) · Der Nervenarzt · doi:10.1007/s00115-002-1302-7 · Cited by 1
How would Consumer Reports rate care in the intensive care unit?*
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Acute lung injury in 2005: A mini-review
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Lower Airway Infection
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“Only two RCTs studied 300 patients in the semi-recumbent position (45°) over the last 5 years [41, 42].”
Background
Commentary Maintenance of tracheal tube cuff pressure: where are the limits?
Ferrer, M., & Torres, A. (2008) · Cited by 1
BACTERIAL INFECTIONS OF THE LUNG
Darling, G. E., Downey, G. P., & Herridge, M. S. (2008) · Elsevier eBooks · doi:10.1016/b978-0-443-06861-4.50045-9 · Cited by 1
Overview of Anesthesiology and Critical Care Medicine
Liu, L. L., & Gropper, M. A. (2010) · Elsevier eBooks · doi:10.1016/b978-0-443-06959-8.00091-1 · Cited by 1
Epidemiologie, Pathogenese und Diagnostik
Heckeshorn, K. (2000) · Cited by 1

Authors: Drakulovic, M. B., Torres, A., Bauer, T. T., Nicolas, J. M., Nogué, S., & Ferrer, M.
Affiliations: Hospital Clínic de Barcelona (ES)
ORCID: Bauer, Torsten T
Nogué, Santiago
Ferrer, Miquel
Venue: The Lancet
Publisher: Elsevier BV
Published: 1999-11
Volume: 354
Issue: 9193
Pages: 1851-1858
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(98)12251-1
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial

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