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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ResultInfluential
Surgical intensive care unit—the trauma surgery perspective
Kleber, C., Schaser, K. D., & Haas, N. (2011) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-011-0765-z · Cited by 8
Managing VAP effectively to optimize outcomes and costs
Powers, J. (2006) · Nursing Management · doi:10.1097/00006247-200611000-00013 · Cited by 8
How does bed frame design influence tissue interface pressure? A comparison of four different technologies designed for long-term or home care
Call, E., & Baker, L. (2007) · Journal of Tissue Viability · doi:10.1016/j.jtv.2007.09.007 · Cited by 8
The efficacy of VAP prophylaxis bundle
Игнатенко, О. В., Bykov, A. O., Tyurin, I. N., Гельфанд, Е. Б., & Николаевич, П. Д. (2018) · Annals of critical care · doi:10.21320/1818-474x-2018-3-39-45 · Cited by 8
Identification of Factors Affecting Mortality in Late-Onset Ventilator-Associated Pneumonia
Hamidi, A. A., & Kescioglu, S. (2020) · Eurasian Journal of Medicine · doi:10.5152/eurasianjmed.2020.20005 · Cited by 8
“EN was found to be a risk factor for nosocomial pneumonia in patients on mechanical ventilation [15].”
Background
Pneumonia associada à ventilação mecânica: análise de fatores epidemiológicos na confecção de estratégias de profilaxia e terapêutica
Neto, E. D. C., de Souza, P. C., Azevedo, F., & Lugarinho, M. E. (2006) · Revista Brasileira de Terapia Intensiva · doi:10.1590/s0103-507x2006000400005 · Cited by 8
Establishing nurse-led ventilator-associated pneumonia surveillance in paediatric intensive care
Richardson, M., Hines, S., Dixon, G. L. J., Highe, L., & Brierley, J. (2010) · Journal of Hospital Infection · doi:10.1016/j.jhin.2009.12.015 · Cited by 8
Preventing Ventilator-Associated Pneumonia - The Role of the Endotracheal Tube
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“05) [56].”
Background
The Effect of a Designed Respiratory Care Program on the Incidence of Ventilator-Associated Pneumonia: A Clinical Trial
Abbasinia, M., Bahrami, N., Bakhtiari, S., Yazdannik, A., & Babaii, A. (2016) · Journal of Caring Sciences · doi:10.15171/jcs.2016.017 · Cited by 8
Nutrition entérale: surveillance et complications
Plantefève, G., Mentec, H., & Bleichner, G. (2007) · Springer eBooks · doi:10.1007/978-2-287-33475-7_43 · Cited by 8
The Impact of Oral Care in the Prevention of Ventilator-Associated Pneumonia: A Narrative Review
Shafipour, V., Haghighi, A., & Bagheri‐Nesami, M. (2018) · Pizhūhish-i parastārī/Pizhūhish-i parastārī · doi:10.21859/ijnr-12064 · Cited by 8
Effect of Early Rehabilitation in the Intensive Care Unit by a Dedicated Therapist Using a Rehabilitation Protocol: A Single-center Retrospective Study
Iwai, K., Hisano, T., Komada, R., Miyai, T., Sakai, K., Torimoto, M., & Tsujita, Y. (2021) · Progress in Rehabilitation Medicine · doi:10.2490/prm.20210030 · Cited by 8
Advances in Surgical Critical Care
Velmahos, G. C., & Alam, H. B. (2008) · Current Problems in Surgery · doi:10.1067/j.cpsurg.2008.03.003 · Cited by 7
“Inadequate initial empiric therapy ncreases the mortality rate in patients with VAP.”
Electrical impedance tomography in the clinical assessment of lung volumes following recruitment manoeuvres
Caruana, L. R., Paratz, J. D., Chang, A. T., & Fraser, J. F. (2011) · Physical Therapy Reviews · doi:10.1179/1743288x10y.0000000021 · Cited by 8
Enteral and parenteral nutrition
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Prevention and Control of Nosocomial Pneumonia
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Maintenance of tracheal tube cuff pressure: where are the limits?
Ferrer, M., & Torres, A. (2008) · Critical Care · doi:10.1186/cc6194 · Cited by 8
“In order to prevent pneumonia, several approaches have been proposed – such as placing patients in the semirecumbent position [3], continuous aspiration of subglottic secretions (CASS) above the tracheal tube cuff [4], oropharyngeal decontamination by antiseptics [5], and the application of antiseptic-impregnated endo…”
Statement of the Fourth International Consensus Conference in Critical Care on ICU-Acquired Pneumonia
(2002) · Réanimation · doi:10.1016/s1624-0693(02)00299-2 · Cited by 8
Análisis de la relevancia y factibilidad de indicadores de calidad en las unidades de nutrición
Folguera, T. M., Hernández, J. Á., Burgos, R., Pérez, S. C., Hernández, M. A. V. C., de Lorenzo, A. G., García‐Luna, P. P., Rocamora, J. A. I., Morales, T. L., Pérez, L. M. L., et al. (2012) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · doi:10.3305/nh.2012.27.1.5557 · Cited by 7
“En la mayoría de los casos contestaba el coordinador o responsable del área de Nutrición perteneciente a la Unidad de Nutrición (20) o al Servicio de Endocrinología y Nutrición (8), Servicio de Medicina Intensiva (4), Farmacia (5) y otros servicios (3).”
Background
Ventilator associated pneumonia and tracheostomy
Cirillo, F., Hinkelbein, J., Romano, G. M., Piazza, O., Servillo, G., & ROBERTIS, E. D. (2015) · Trends in Anaesthesia and Critical Care · doi:10.1016/j.tacc.2015.10.003 · Cited by 7
Recommendations for specialized nutritional-metabolic management of the critical patient: Monitoring and safety. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)
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Minimising exposure to respiratory droplets, ‘jet riders’ and aerosols in air-conditioned hospital rooms by a ‘Shield-and-Sink’ strategy
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“…dynamics principles (Reynolds number in the turbulent regime), favouring air mixing and thus potentially transporting aerosol-loaded air from non-breathing zones towards breathing zones; therefore, the benefit of just increasing ventilation has limitations that depend on the specific…”
Gastric Feeding as an Extension of an Established Enteral Nutrition Protocol
Marr, A. B., McQuiggan, M. M., Kozar, R. A., & Moore, F. A. (2004) · Nutrition in Clinical Practice · doi:10.1177/0115426504019005504 · Cited by 7
Nonpharmacologic Measures to Prevent Ventilator-Associated Pneumonia
Lorente, L. (2008) · Clinical Pulmonary Medicine · doi:10.1097/cpm.0b013e31816728ac · Cited by 7
“In the study of Drakulovic et al, the semirecumbent position reduced the incidence of VAP, especially in patients who received enteral nutrition.(64) Thus, patients should remain in the semirecumbent position, especially in patients receiving enteral nutrition.”
Background
Can we prevent the spread of focal lung inflammation?
Marini, J. J. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181f20f01 · Cited by 7
“Although appropriate tracheal orientation limits the extent to which it occurs (27), contamination of the trachea and lower tracheobronchial tree by oropharyngeal contents with high microbial colony counts may be unavoidable in the customary 30-degree (head up) supine position (28).”
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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