Infection control · Positioning to prevent pneumonia
Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients
| Design | Randomised controlled trial |
|---|---|
| Treatment | Semirecumbent position at 45 degrees |
| Control | Supine position |
| Population | 86 mechanically ventilated patients |
| Follow-up | ICU stay |
| Primary endpoint | Clinically suspected nosocomial pneumonia |
| Result | Clinically suspected nosocomial pneumonia occurred in 3 of 39 (8%) semirecumbent patients versus 16 of 47 (34%) supine patients (95% CI for the difference 10.0 to 42.0). The effect was greatest in patients receiving enteral nutrition. |
| Secondary endpoints | Microbiologically confirmed pneumonia, interaction with enteral feeding |
The semirecumbent body position reduces frequency and risk of nosocomial pneumonia, especially in patients who receive enteral nutrition.
The trial authors, in the published abstract
The basis for head-of-bed elevation in every ventilator care bundle, on 86 patients. van Nieuwenhoven 2006 then showed that 45 degrees is almost never actually achieved in practice, which makes the real-world benefit far less certain than the bundle implies.
Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999 Nov 27;354(9193):1851-8.