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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Ventilator associated pneumonia and infection control
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Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia – Chicago, Illinois, May 2002
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Method
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Background
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Background
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Background
Following tracheal intubation, mucus flow is reversed in the semirecumbent position: possible role in the pathogenesis of ventilator-associated pneumonia
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Background
Early enteral nutrition in mechanically ventilated patients in the prone position
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“Body position and enteral nutrition are independent risk factors for ventilator-associated pneumonia, especially when present in combination (17, 37).”
Background
Ventilator-Associated Pneumonia—The Wrong Quality Measure for Benchmarking
Klompas, M., & Platt, R. G. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-11-200712040-00013 · Cited by 120
“Until new outcome measures are developed, we recommend an interim strategy of tracking evidence-based process-of-care measures, such as daily cessation of sedation and appropriate patient positioning, because these practices have been shown to reduce intensive care length of stay and duration of mechanical ventilation…”
Decreasing Ventilator-Associated Pneumonia in a Trauma ICU
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Azab, S. F. A., Sherbiny, H. S., Saleh, S. H. A., Elsaeed, W. F., Elshafiey, M. M., Siam, A. G., Arafa, M. A., Alghobashy, A. A., Bendary, E. A., Basset, M. A. A., et al. (2015) · BMC Infectious Diseases · doi:10.1186/s12879-015-1062-1 · Cited by 115
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Flanders, S. A., Collard, H. R., & Saint, S. K. (2006) · American Journal of Infection Control · doi:10.1016/j.ajic.2005.07.003 · Cited by 115
Swallowing Dysfunction After Critical Illness
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How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients
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Background
Barriers to translating evidence into practice
Berenholtz, S. M., & Pronovost, P. J. (2003) · Current Opinion in Critical Care · doi:10.1097/00075198-200308000-00012 · Cited by 111
Ivermectin Toxicity in 17 Collies
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“Body Positioning The American Gastroenterological Association recommends elevating the head of bed to a minimum of 30o to 45o to reduce the risk of microaspiration.(6,15,31) Elevation to 30o is an accepted standard of care for patients receiving mechanical ventilation to minimize risk of ventilator-associated pneumoni…”
Background
An Appraisal of Multivariable Logistic Models in the Pulmonary and Critical Care Literaturea
Moss, M. M., Wellman, A., & Cotsonis, G. (2003) · CHEST Journal · doi:10.1378/chest.123.3.923 · Cited by 108
Pepsin, a Marker of Gastric Contents, Is Increased in Tracheal Aspirates From Preterm Infants Who Develop Bronchopulmonary Dysplasia
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“There is evidence that retrograde flow of gastric and duodenal content is one of the main causes of nosocomial pneumonia caused by direct aspiration of colonized gastroduodenal reflux as well as abnormal oropharyngeal colonization and subsequent microaspirations (1, 13).”
Background
Strategies to Prevent Ventilator-Associated Pneumonia in Neonates
Garland, J. S. (2010) · Clinics in Perinatology · doi:10.1016/j.clp.2010.05.003 · Cited by 105
“oropharyngeal and gastrointestinal contents in adults.(30) Aly and colleagues(31) reduced tracheal colonization from oropharyngeal contamination through lateral positioning of infants.”
Background
Hospital-Associated Infections in Small Animal Practice
Stull, J. W., & Weese, J. S. (2015) · Veterinary Clinics of North America Small Animal Practice · doi:10.1016/j.cvsm.2014.11.009 · Cited by 105
“In human medicine, several factors, such as recumbent position, mechanical ventilation, and use of endotracheal or nasogastric tubes, are likely to increase the risk for HA pneumonia.(12,13) This topic has been minimally investigated in the veterinary field, in large part because of the limited use of mechanical venti…”
Background
Bacteremia and Sepsis in Older Adults
Girard, T. D., & Ely, E. W. (2007) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2007.05.003 · Cited by 109
Central or Peripheral Catheters for Initial Venous Access of ICU Patients: A Randomized Controlled Trial
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“This is the result of the completion of many randomized controlled trials (RCT), which addressed diverse conditions such as the prevention of gastroduodenal bleeding (2) or ventilator-associated pneumonia (3, 4) and the treatment of septic shock (5) or acute respiratory distress syndrome (6– 9).”
BTS clinical statement on aspiration pneumonia
Simpson, A. J., Allen, J.-L., Chatwin, M., Crawford, H., Elverson, J., Ewan, V. C., Forton, J. T., McMullan, R., Plevris, J. N., Renton, K., et al. (2023) · Thorax · doi:10.1136/thorax-2022-219699 · Cited by 110
“There is good evidence that raising the head of the bed, for example by nursing critically ill patients at between 30° and 45° reduces the likelihood of VAP, 194 195 though maintaining this position in practice is challenging.”
Airway colonisation in long-term mechanically ventilated patients
Girou, E., Buu-Hoï, A., Stéphan, F., Novara, A., Gutmann, L., Safar, M. E., & Fagon, J.-Y. (2004) · Intensive Care Medicine · doi:10.1007/s00134-003-2077-4 · Cited by 103
“Both methods have been shown to decrease the incidence of VAP in randomised controlled trials [9, 10, 11, 12, 13].”
Method
The morbidity of Guillain-Barré syndrome admitted to the intensive care unit
Henderson, R. D., Lawn, N. D., Fletcher, D. D., McClelland, R. L., & Wijdicks, E. F. M. (2003) · Neurology · doi:10.1212/01.wnl.0000035640.84053.5b · Cited by 102
Evidence-Based Practice: Use of the Ventilator Bundle to Prevent Ventilator-Associated Pneumonia
Tolentino-DelosReyes, A. F., Ruppert, S. D., & Shiao, S.-Y. P. K. (2007) · American Journal of Critical Care · doi:10.4037/ajcc2007.16.1.20 · Cited by 101
Improving Care for the Ventilated Patient
Berenholtz, S. M., Milanovich, S., Faircloth, A. C., Prow, D. T., Earsing, K. A., Lipsett, P. A., Dorman, T., & Pronovost, P. J. (2004) · The Joint Commission Journal on Quality and Safety · doi:10.1016/s1549-3741(04)30021-3 · Cited by 100
Nasoenteric Tube Complications
Prabhakaran, S., Doraiswamy, V. A., Nagaraja, V., Cipolla, J., Ofurum, U., Evans, D. C., Lindsey, D., Seamon, M. J., Kavuturu, S., Gerlach, A. T., et al. (2012) · Scandinavian Journal of Surgery · doi:10.1177/145749691210100302 · Cited by 100
Effect of Backrest Elevation on the Development of Ventilator-Associated Pneumonia
Grap, M. J., Munro, C. L., Hummel, R. S., Elswick, R. K., McKinney, J. L., & Sessler, C. N. (2005) · American Journal of Critical Care · doi:10.4037/ajcc2005.14.4.325 · Cited by 100
The attributable cost and length of hospital stay because of nosocomial pneumonia in intensive care units in 3 hospitals in Argentina: A prospective, matched analysis
Rosenthal, V., Guzmán, S., Migone, O., & Safdar, N. (2005) · American Journal of Infection Control · doi:10.1016/j.ajic.2004.08.008 · Cited by 98
Intrahospital transport of critically ill ventilated patients: A risk factor for ventilator-associated pneumonia—A matched cohort study
Barker, J. A. (2007) · Yearbook of Pulmonary Disease · doi:10.1016/s8756-3452(08)70490-0 · Cited by 96
Variable compliance with clinical practice guidelines identified in a 1-day audit at 66 French adult intensive care units*
Léone, M., Ragonnet, B., Alonso, S., Allaouchiche, B., Constantin, J., Jaber, S., Martin, C., Fabbro-Péray, P., & Lefrant, J. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e31826571f2 · Cited by 97
“Nevertheless, in the prevention of ventilator-associated pneumonia, this recommendation is based on a strong level of evidence (33, 34).”
Background
Risk and prognostic factors of ventilator-associated pneumonia in trauma patients
Cavalcanti, M. A. D. N., Ferrer, M., Ferrer, R., Morforte, R., Garnacho, A., & Torres, A. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000206471.44161.a0 · Cited by 96
“The need for supine position in patients with cervical fracture, a risk factor for VAP (30), may have influenced this association.”
Background
Pharmacotherapy for Prevention and Treatment of Acute Respiratory Distress Syndrome
Bosma, K. J., Taneja, R., & Lewis, J. F. (2010) · Drugs · doi:10.2165/10898570-000000000-00000 · Cited by 97
“These include cautious fluid management,([26,27]) adequate nutrition,([28]) prevention of ventilator associated pneumonia,([29-32]) prophylaxis for deep venous thrombosis([33]) and gastric ulcers,([34]) weaning of sedation and mechanical ventilation as early as possible,([35]) and physiotherapy and rehabilitation.”
Background
The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide
DePalo, V. A., McNicoll, L., Cornell, M., Rocha, J. M., Adams, L. E., & Pronovost, P. J. (2010) · BMJ Quality & Safety · doi:10.1136/qshc.2009.038265 · Cited by 93
Prävention der nosokomialen beatmungsassoziierten Pneumonie
- (2013) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-013-1846-7 · Cited by 94
Postoperative Pulmonary Complications: Pneumonia and Acute Respiratory Failure
Sachdev, G., & Napolitano, L. M. (2012) · Surgical Clinics of North America · doi:10.1016/j.suc.2012.01.013 · Cited by 97
Hospital-Onset Infections: A Patient Safety Issue
Gerberding, J. L. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-137-8-200210150-00011 · Cited by 95
“Tube misplacement, tube displacement, unrecognized ileus, gastric distension, and supine patient positioning commonly contribute to hospital-onset aspiration pneumonia (13, 14, 22).”
Background
Potential Strategies to Prevent Ventilator-associated Events
Klompas, M. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201506-1161ci · Cited by 101
Randomized Intubation with Polyurethane or Conical Cuffs to Prevent Pneumonia in Ventilated Patients
Philippart, F., Gaudry, S., Quinquis, L., Lau, N., Ouanes, I., Touati, S., Nguyen, J. C., Branger, C., Faibis, F., Mastouri, M., et al. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201408-1398oc · Cited by 94
An evidence-based recommendation on bed head elevation for mechanically ventilated patients
Niël-Weise, B. S., Gastmeier, P., Kola, A., Vonberg, R. P., Wille, J. C., van den Broek, P. J., & the Bed Head Elevation Study Group (2011) · Critical Care · doi:10.1186/cc10135 · Cited by 93
“Three RCTs compared 45° bed head elevation (treatment group) with respectively 25° [19], 10° [20], or 0° [8] elevations (control groups) in adult ventilated ICU patients with a mean ventilation time varying from 4 days [19] to 7 days [8].”
BackgroundMethodResultInfluential
Before–after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position
Reignier, J., Dimet, J., Martin‐Lefèvre, L., Bontemps, F., Fiancette, M., Clementi, E., Lebert, C., & Renard, B. (2009) · Clinical Nutrition · doi:10.1016/j.clnu.2009.08.004 · Cited by 92
Eliminating Nosocomial Infections at Ascension Health
Berriel‐Cass, D., Adkins, F. W., Jones, P., & Fakih, M. G. (2006) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(06)32079-x · Cited by 92
An evaluation of the impact of the ventilator care bundle
Crunden, E., Boyce, C. M., Woodman, H., & Bray, B. (2005) · Nursing in Critical Care · doi:10.1111/j.1362-1017.2005.00134.x · Cited by 91
“The ventilator care bundle is based on a number of peer-reviewed studies (Torres et al., 1992; Drakulovic et al., 1999; Kress et al., 2000; Cook et al., 2002).”
Background
Resources to Enhance Evidence-based Nursing Practice
Ciliska, D. K., Pinelli, J. M., DiCenso, A., & Cullum, N. A. (2001) · AACN Clinical Issues Advanced Practice in Acute & Critical Care · doi:10.1097/00044067-200111000-00008 · Cited by 91
Effect of standardized orders and provider education on head-of-bed positioning in mechanically ventilated patients
Helman, D. L., Sherner, J. H., Fitzpatrick, T. M., Callender, M. E., & Shorr, A. F. (2003) · Critical Care Medicine · doi:10.1097/01.ccm.0000079609.81180.15 · Cited by 90
“(10) randomly assigned mechanically ventilated patients to have their head-of-bed angle maintained in either the semirecumbent (45 degrees) or supine (0 degrees) position.”
Background
Ventilator-Associated Pneumonia: Preventing the Inevitable
Bonten, M. J. M. (2010) · Clinical Infectious Diseases · doi:10.1093/cid/ciq075 · Cited by 88
“Reported effects of different measures for ventilator-associated pneumonia (VAP) prevention in selected randomized studies involving intensive care unit (ICU) patients Intervention Reference Total no. of patients in the study RRR of VAP, % (95% CI) RRR of mortality, % (95% CI) Remarks Head-of-bed elevation Drakulovic…”
Background
Nursing care of the mechanically ventilated patient: What does the evidence say?
Couchman, B. A., Wetzig, S. M., Coyer, F. M., & Wheeler, M. K. (2007) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2006.08.005 · Cited by 92
An Intensive Care Unit Quality Improvement Collaborative in Nine Department of Veterans Affairs Hospitals: Reducing Ventilator-Associated Pneumonia and Catheter-Related Bloodstream Infection Rates
Bonello, R. S., Fletcher, C. E., Becker, W. K., Clutter, K., Arjes, S. L., Cook, J. J., & Petzel, R. A. (2008) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(08)34081-1 · Cited by 88
Improving patients' safety locally: changing clinician behaviour
Cook, D., Montori, V. M., Jp, M., Finfer, S. R., & Rocker, G. M. (2004) · The Lancet · doi:10.1016/s0140-6736(04)15955-2 · Cited by 89
Ventilator associated pneumonia
Hunter, J. D. (2006) · Postgraduate Medical Journal · doi:10.1136/pgmj.2005.036905 · Cited by 88
Ventilator-Associated Events: What They Are and What They Are Not
Klompas, M. (2019) · Respiratory Care · doi:10.4187/respcare.07059 · Cited by 87
Enteral feeding in the critically ill: comparison between the supine and prone positions: a prospective crossover study in mechanically ventilated patients
van der Voort, P. H., & Zandstra, D. F. (2001) · Critical Care · doi:10.1186/cc1026 · Cited by 86
“quent aspiration and infection [16,17].”
Cost of a Ventilator-Associated Pneumonia in a Shock Trauma Intensive Care Unit
Cocanour, C. S., Ostrosky‐Zeichner, L., Peninger, M., Garbade, D., Tidemann, T., Domonoske, B. D., Li, T., Allen, S. J., & Luther, K. M. (2005) · Surgical Infections · doi:10.1089/sur.2005.6.65 · Cited by 85
“…data showing improved outcome in mechanically ventilated patients for several therapies or processes of care, including elevating the head of bed [16], stress gas-tritis prophylaxis [17], deep vein thrombosis prophylaxis [18], and holding sedation so that patients can follow commands once a day…”
American Burn Association Practice Guidelines for Prevention, Diagnosis, and Treatment of Ventilator-Associated Pneumonia (VAP) in Burn Patients
Mosier, M. M., & Pham, T. N. (2009) · Journal of Burn Care & Research · doi:10.1097/bcr.0b013e3181bfb68f · Cited by 82
Tracheostomy in Critically Ill Patients
Rana, S., Pendem, S., Pogodzinski, M. S., Hubmayr, R. D., & Gajic, O. (2005) · Mayo Clinic Proceedings · doi:10.4065/80.12.1632 · Cited by 85
Sepsis during pregnancy
Pérez, E. R. F., Salman, S. S., Pendem, S., & Farmer, J. C. (2005) · Critical Care Medicine · doi:10.1097/01.ccm.0000182479.63108.cd · Cited by 84
“Mechanically ventilated patients should be maintained in a semirecumbent position by elevating the head of the bead to 45 degrees to prevent ventilator-associated pneumonia, unless contraindicated (112).”
Background
Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit
Dunham, C. M., Brocker, B. P., Collier, B. D., & Gemmel, D. J. (2008) · Critical Care · doi:10.1186/cc6957 · Cited by 85
“Supine position during mechanical ventilation was found to be a risk factor for VAP [59].”
BackgroundMethod
Introduction: Improving Patient Safety Through Infection Control: A New Healthcare Imperative
Yokoe, D. S., & Classen, D. C. (2008) · Infection Control and Hospital Epidemiology · doi:10.1086/591063 · Cited by 85
“sistently linked to improvement of outcomes in the medical literature.(23,24) A systematic review of the evidence to support practices relevant to improving patient safety, published by”
Background
A continuous quality-improvement program reduces nosocomial infection rates in the ICU
Misset, B., Timsit, J., Mf, D., Garrouste-Orgeas, M., Chalfine, A., Flouriot, I., Goldstein, F. W., & Carlet, J. M. (2003) · Intensive Care Medicine · doi:10.1007/s00134-003-2096-1 · Cited by 85
“established in late 1999 [10], 7 months before the end of”
BackgroundMethod
High Incidence of Respiratory Infections in ‘Nil by Mouth’ Tube-Fed Acute Ischemic Stroke Patients
Langdon, P. C., Lee, A. H., & Binns, C. W. (2008) · Neuroepidemiology · doi:10.1159/000177036 · Cited by 84
“However, it is difficult to determine whether aspiration of colonized oropharyngeal secretions or aspiration of refluxed gastric contents is the major contributor to the development of aspiration pneumonia [”
Background
Nutrition (A.S.P.E.N.) Patient: : Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill
McClave, S. A., Martindale, R. G., Vanek, V. W., McCarthy, M. S., Roberts, P. R., & Taylor, B. E. (2009) · Cited by 81
Preventing Ventilator-Associated Pneumonia
O’Grady, N. P., Murray, P. R., & Ames, N. J. (2012) · JAMA · doi:10.1001/jama.2012.6445 · Cited by 79
“In 2 small studies, aspiration and VAP were reduced almost 3-fold for patients with the head of the bed at 45° compared with patients who were supine.(11,26) Although elevating the head of the bed is better than the supine position, a 45° elevation is difficult to achieve(27) because sedated patients are unable to kee…”
Background
Effect of patient positioning on intra-abdominal pressure monitoring
McBeth, P. B., Zygun, D. A., Widder, S. L., Cheatham, M. L., Zengerink, I., Glowa, J., & Kirkpatrick, A. W. (2007) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2007.01.013 · Cited by 81
Pepsin as a Marker for Pulmonary Aspiration
Metheny, N. A., Chang, Y., Ye, J. S., Edwards, S. J., Defer, J. E., Dahms, T. E., Stewart, B. J., Stone, K., & Clouse, R. E. (2002) · American Journal of Critical Care · doi:10.4037/ajcc2002.11.2.150 · Cited by 81
Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units
van Nieuwenhoven, C. A., Buskens, E., Bergmans, D. C. J. J., van Tiel, F. H., Ramsay, G., & Bonten, M. J. M. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000104111.61317.4b · Cited by 81
“Many strategies have been developed to reduce the prevalence of VAP, such as selective decontamination of the digestive tract (SDD), oropharyngeal decontamination (OD) (7–10), the use of sucralfate for stress-ulcer prophylaxis (11), continuous subglottic suctioning (12), and semirecumbent positioning of patients (13,…”
Background
Effects of elevating the head of bed on interface pressure in volunteers
Peterson, M., Schwab, W. K., McCutcheon, K., van Oostrom, J. H., Gravenstein, N. L., & Caruso, L. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e31818b8dbd · Cited by 80
Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients
Kostadima, E., Kaditis, A. G., Alexopoulos, E. Ι., Zakynthinos, E., & Sfyras, D. (2005) · European Respiratory Journal · doi:10.1183/09031936.05.00096104 · Cited by 80
“Patients were orally intubated [13], placed on the ICU bed in a semi-recumbent position (30–45u) [ 14 ] and tracheostomy was not performed until completion of 3 weeks of MV. No closed circuits for tracheal suctioning were used [15].”
Method
Automatic regulation of the cuff pressure in endotracheally-intubated patients
Farré, R., Rotger, M., Ferrer, M., Torres, A., & Navajas, D. (2002) · European Respiratory Journal · doi:10.1183/09031936.02.02692001 · Cited by 80
Effects of Sitting Position and Applied Positive End-Expiratory Pressure on Respiratory Mechanics of Critically Ill Obese Patients Receiving Mechanical Ventilation*
Lemyze, M., Mallat, J., Duhamel, A., Pepy, F., Gasan, G., Barrailler, S., Vangrunderbeeck, N., Tronchon, L., & Thévenin, D. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e318298637f · Cited by 80
“positioning on mechanically ventilated patients (29, 30).”
The role of body position and gravity in the symptoms and treatment of various medical diseases
Pan, M.-D., Benoit, R., & Girardier, L. (2004) · Swiss Medical Weekly · doi:10.4414/smw.2004.09765 · Cited by 78

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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