Effect of 45°semirecumbent position on ventilator-associated pneumonia in mechanical ventilated patients:a meta-analysis

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Author:
LENG Yu-xin(Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China)
SONG Ya-han()
YAO Zhi-yuan(Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China)
ZHU Xi(Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China)
Journal Title:
Chinese Critical Care Medicine
Issue:
Volume 24, Issue 10, 2012
DOI:
10.3760/cma.j.issn.1003-0603.2012.10.004
Key Word:
Body position; 45°semirecumbent position; 25°-30° position; Mechanical ventilation;Ventilator associated pneumonia; Meta analysis

Abstract: Objective To systemically analyze the effect of 45° semirecumbent position on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients,and to evaluate whether 45° semirecumbent position is superior to 25°-30° head of bed (HOB).Methods The randomized controlled trials (RCTs) comparing the effect of different HOB on the outcomes of mechanical ventilated patients were searched (from 1st January 1990 to 20th July 2012) from five databases including the Cochrane Central Register of Controlled Trials,MEDLINE,Embase,China Knowledge Resource Integrated Database (CNKI),and Wanfang Database.Meta analysis was conducted using RevMan 5.0 software.Results Data extracted from five RCTs with a total of 427 patients were analyzed.The risks of developing clinically diagnosed VAP were significantly lower among the patients in semirecumbent 45° position compared to the patients in lower position [ 15.96% (34/213 ) vs.26.64% (57/214),relative risk (RR)=0.57,95% confidence interval (95% CI) 0.39 to 0.83,P=0.003],while no significant differences were detected between the two groups regarding the mortality rate [ 27.04% ( 53/196 ) vs.28.22% (57/202),RR =0.93,95% CI 0.68to 1.27,P=0.66],the length of intensive care unit (ICU) stay [weighted mean difference (WMD)=-0.45,95% CI-1.08 to 0.18,P=0.16]and the percentage of antibiotics treatment [71.11% (32/45) vs.60.87% (28/46),RR=1.14,95%CI 0.85 to 1.53,P=0.37].Two of the five trials (91 patients) were included in the sub-analysis between 45° group (45 patients ) and 25 ° -30° group (46 patients).The results showed that comparing with 25 ° -30°,45°semirecumhent position had no significance in improving patients' clinical outcomes.Conclusion This study proved that the clinically preferred semirecumbent 45° position did have effect in reducing the incidence of VAP,nevertheless,whether it's superior to 25° -30° needs to be confirmed by larger-scale,higher-quality RCTs.

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