Preventing ventilator-associated pneumonia : comparing the semi-recumbent with the prone and supine positions

Abstract

Preventing ventilator-associated pneumonia: Comparing the semi-recumbent with the prone and supine positions. Overview: Ventilator-associated pneumonia (V AP) is a leading cause of morbidity and mortality in the intensive care unit. Several strategies can be applied to reduce the incidence of this infection, one of which is body positioning. Research question: In adult mechanically-ventilated patients, is the semi-recumbent position more effective than the prone or supine positions in reducing the incidence of ventilator-associated pneumonia? This was formulated on the basis of the PICO model, where the population (P) includes adult mechanically ventilated patients in a critical care setting, the intervention and comparison (I, C) are different body positions which can be adopted, namely the prone, semi-recumbent and supine positions, and the outcome (0) is a reduced incidence of V AP. Inclusion criteria: Studies (1) published from 1995 onwards, (2) considering adult trauma patients, post-operative patients, or patients with respiratory disorders requiring mechanical ventilation as their population, and (3) classified as randomised controlled trials and systematic literature reviews. Exclusion criteria: Studies (1) dating pre-1995, (2) with neonates and paediatric patients as their population (3) not in the English language, (4) discussing interventions other than body positions, (5) classified as narrative literature reviews and opinion articles. Outcome: Titles and abstracts of 80 articles were reviewed for relevance. Ultimately, 6 systematic literature reviews and 4 randomised controlled trials were included. Method: All articles were appraised utilising the Critical Appraisal Skills Programme (CASP) appraisal tools for systematic literature reviews and randomised controlled trials. Results: A semi-recumbent body position is more effective than the supine position in reducing the incidence of V AP; however evidence on the prone position was inconclusive. Conclusion, implications, and recommendations: A semi-recumbent body position is recommended to reduce the incidence of VAP; however, more research needs to be directed towards the effectiveness of prone positioning, and towards identifying the lowest angle of head of bed elevation which remains effective in this respect. Keywords: (1) VENTILATOR-ASSOCIATED PNEUMONIA. (2) MECHANICAL VENTILATION. (3) POSITIONING. (4) CRITICAL CARE. (5) INFECTION PREVENTION. (6) SEMIRECUMBENT POSITION.