Τίτλος:
Impact of patient position on the incidence of ventilator-associated
pneumonia: A meta-analysis of randomized controlled trials
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objective: The aim of this study is to summarize the effect of position
(prone and semirecumbent 45 degrees) of mechanically ventilated patients
on the incidence of ventilator-associated pneumonia (VAP) and other
outcomes.
Methods: A systematic search for randomized control trials (RCTs) was
done. We estimated pooled odds ratios (ORs) and 95% confidence
intervals (CIs) using fixed effects model or random effects model, where
appropriate. For continuous variables, we calculated the estimation of
weighted mean differences.
Results: We analyzed data extracted from 3 RCTs studying the
semirecumbent 45 degrees and 4 RCTs studying the prone position with a
total of 337 and 1018 patients, respectively. The odds of developing
clinically diagnosed VAP were significantly lower among patients in the
semirecumbent 45 degrees position compared to patients in the supine
position (OR = 0.47; 95% CI, 0.27-0.82; 337 patients). The comparison
of prone vs supine position group showed a moderate trend toward better
outcomes regarding the incidence of clinically diagnosed VAP among
patients in the prone position (OR = 0.80; 95% CI, 0.60-1.08; 10 18
patients). The subanalysis regarding the incidence of microbiologically
documented VAP, the length of intensive care unit stay, and the duration
of mechanical ventilation showed that patients in the semirecumbent 45
degrees position have a moderate trend toward better clinical outcomes.
Conclusion: This meta-analysis provides additional evidence that the
usual practice of back-rest elevation of 15 degrees to 30 degrees is not
sufficient to prevent VAP in mechanically ventilated patients. Patients
positioned semirecumbently 45 degrees have significantly lower incidence
of clinically diagnosed VAP compared to patients positioned supinely. On
the other hand, the incidence of clinically diagnosed VAP among patients
positioned pronely does not differ significantly from the incidence of
clinically diagnosed VAP among patients positioned supinely. (C) 2009
Elsevier Inc. All rights reserved.
Συγγραφείς:
Alexiou, Vangetis G.
Ierodiakonou, Vrettos
Dimopoutos, George
and Falagas, Matthew E.
Περιοδικό:
Journal of Critical Care
Εκδότης:
W B SAUNDERS CO-ELSEVIER INC
Λέξεις-κλειδιά:
Semirecumbent position; Prone position; Supine position;
Ventilator-associated pneumonia (VAP)
DOI:
10.1016/j.jcrc.2008.09.003
