A target backrest elevation of 45° was not feasible for mechanically ventilated patients; elevations achieved did not prevent ventilator associated pneumonia
Q In critically ill patients on mechanical ventilation, is a semirecumbent position of 45° feasible and effective for prevention of ventilator associated pneumonia (VAP)?
METHODS
Design:
randomised controlled trial.
Allocation:
concealed.
Blinding:
blinded (outcome assessors).
Follow up period:
median 5–6 days (range 0–64 d).
Setting:
4 intensive care units (ICUs) in 3 university hospitals in the Netherlands.
Patients:
221 adults (mean age 64 y, 63% men) who were intubated within 24 hours of ICU admission and had an expected duration of ventilation ⩾48 hours.
Intervention:
semirecumbent position (backrest 45° from horizontal) (n = 112) or supine position (10°) (n = 109) for the duration of ventilation. A nurse adjusted the backrest of the bed to the allocated position 2–3 times daily, but it could be changed at patient request or as required for care.
Outcomes:
microbiologically confirmed VAP, pressure …
