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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Prognostic Role of Clinical and Laboratory Criteria To Identify Early Ventilator-Associated Pneumonia in Brain Injury*
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Nursing considerations to complement the Surviving Sepsis Campaign guidelines
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BackgroundInfluential
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Background
Recognition and prevention of nosocomial pneumonia in the intensive care unit and infection control in mechanical ventilation
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“Supine positioning facilitates aspiration in the intubated patient and should be avoided if clinically possible (108).”
Background
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Fisioterapia no paciente sob ventilação mecânica
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Background
Impact of polyurethane on variations in tracheal cuff pressure in critically ill patients: a prospective observational study
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“Supine position was identified as a risk factor for aspiration of gastric content and VAP [ 31 ].”
Background
A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation
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“Additionally, lower head-of-bed (HOB) elevations have been associated with higher rates of aspiration.(6-11) Despite the evidence that HOB elevation (30o-45o) helps prevent aspiration in patients receiving mechanical ventilation, the intervention is underused.”
Background
Adherence to simple and effective measures reduces the incidence of ventilator-associated pneumonia
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“Other strategies, such as elevation of the head of the bed of ventilated patients, seems to both reduce the prevalence of pneumonia and to better preserve pulmonary function (105).”
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“Also, patient immobilization and recumbancy [41,42], as well as inattention to isolation precautions, inadequate exchange or misuse of gloves, or inadequate adherence to hand-washing protocol may contribute to organism load [43].”
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Sepsis, Severe Sepsis, and Septic Shock
Munford, R. S., & Suffredini, A. F. (2010) · Elsevier eBooks · doi:10.1016/b978-0-443-06839-3.00070-9 · Cited by 55
The pulmonary physician in critical care * 4: Nosocomial pneumonia
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Quality Indicators for Hospitalization and Surgery in Vulnerable Elders
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Gastrointestinal Dysmotility: Clinical Consequences and Management of the Critically Ill Patient
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Ventilator-associated pneumonia
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Enteral Nutrition in the Critically Ill
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“The results of the study by Drakulovic et al (116) have, however, not been reproduced.”
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Background

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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