Infection control · Positioning to prevent pneumonia
Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia
| Design | Multicentre randomised study |
|---|---|
| Treatment | Targeted backrest elevation of 45 degrees |
| Control | Standard supine positioning |
| Population | 221 mechanically ventilated patients: 109 supine and 112 semirecumbent |
| Follow-up | ICU stay |
| Primary endpoint | Incidence of ventilator-associated pneumonia |
| Result | The 45-degree target was never reached. Average elevations achieved were 9.8 degrees in the supine group and 28 degrees in the semirecumbent group, and the achieved difference in position did not reduce ventilator-associated pneumonia. |
| Secondary endpoints | Achieved backrest elevation, mortality, length of stay |
The targeted backrest elevation of 45 degrees for semirecumbent positioning was not reached in the conditions of the present randomized study.
The trial authors, in the published abstract
An honest implementation failure that is more informative than a clean result would have been. It does not refute Drakulovic 1999 so much as show that the intervention cannot be delivered as specified — a distinction worth remembering whenever a care bundle specifies an angle.
van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH, et al. Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med 2006 Feb;34(2):396-402.