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

( views:437, downloads:0 )
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
Volume 24, Issue 10, 2012
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.

  • [1]Ashraf M,Ostrosky-Zeichner L.Ventilator-associated pneumonia:a review.Hosp Pract (Minneap),2012,40:93-105.
  • [2]王少利,安卫红,李宏亮,等.北京市某三级甲等医院综合重症监护病房患者器械相关感染的监测分析.中国危重病急救医学,2011,23:681-684.
  • [3]Berra L,Sampson J,Fumagalli J,et al.Alternative approaches to ventilator-associated pneumonia prevention.Minerva Anestesiol,2011,77:323-333.
  • [4]Metheny NA,Clouse RE,Chang YH,et al.Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients:frequency,outcomes,and risk factors.Crit Care Med,2006,34:1007-1015.
  • [5]A1-Tawfiq JA,Abed MS.Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle.Am J Infect Control,2010,38:552-556.
  • [6]宋海晶,刘京涛,高素芹,等.呼吸机集束化治疗依从性及有效性的临床研究.中国危重病急救医学,2009,21:660-663.
  • [7]Callcut RA.What is the best position for preventing ventilator-associated pneumonia?.Respir Care,2010,55:353-354.
  • [8]Leng YX,Yi M,Nie CY,et al.30° is more appropriate for the critically ill patients receiving mechanical ventilation.J Crit Care,In submission.
  • [9]Moher D,Pham B,Jones A,et al.Does quality of reports of randomized trials affect estimates of intervention efficacy reported in meta-analyses?.Lancet,1998,352:609-613.
  • [10]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,1999,354:1851-1858.
  • [11]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,2006,34:396-402.
  • [12]肖鹏妹,瘳绿梅,蔡芬,等.体位护理对机械通气相关性肺炎影响的研究.中华现代护理杂志,2006,12:1177-1178.
  • [13]Keeley L.Reducing the risk of ventilator-acquired pneumonia through head of bed elevation.Nurs Crit Care,2007,12:287-294.
  • [14]Ni(e)l-Weise BS,Gastmeier P,Kola A,et al.An evidence-based recommendation on bed head elevation for mechanically ventilated patients.Crit Care,2011,15:R111.
  • [15]Alexiou VG,Ierodiakonou V,Dimopoulos G,et al.Impact of patient position on the incidence of ventilator-associated pneumonia:a meta-analysis of randomized controlled trials.J Crit Care,2009,24:515-522.
  • [16]刘增霞,任蔚虹,潘海燕.半卧位对呼吸机相关肺炎影响的Meta分析.中华急诊医学杂志,2011,20:147-150.
  • [17]Cheatham ML,De Waele JJ,De Laet I,et al.The impact of body position on intra-abdominal pressure measurement:a multicenter analysis.Crit Care Med,2009,37:2187-2190.
  • [18]McBeth PB,Zygun DA,Widder S,et al.Effect of patient positioning on intra-abdominal pressure monitoring.AM J SURG P,2007,193:644-647.
  • [19]Vasquez DG,Berg-Copas GM,Wetta-Hall R.Influence of semi-recumbent position on intra-abdominal pressure as measured by bladder pressure.J Surg Res,2007,139:280-285.
  • [20]冷玉鑫,张楠,朱曦,等.抬高体位对机械通气患者腹腔压力和胃食管反流的综合影响.中国危重病急救医学,2011,23:534-538.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn