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A target backrest elevation of 45° was not feasible for mechanically ventilated patients; elevations achieved did not prevent ventilator associated pneumonia

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Q In critically ill patients on mechanical ventilation, is a semirecumbent position of 45° feasible and effective for prevention of ventilator associated pneumonia (VAP)?


Embedded ImageDesign:

randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:

blinded (outcome assessors).

Embedded ImageFollow up period:

median 5–6 days (range 0–64 d).

Embedded ImageSetting:

4 intensive care units (ICUs) in 3 university hospitals in the Netherlands.

Embedded ImagePatients:

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.

Embedded ImageIntervention:

semirecumbent position (backrest 45° from horizontal) (n = 112) or supine position (10°) (n = 109) for the duration of ventilation. A nurse …

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  • For correspondence: Dr M J Bonten, University Medical Center Utrecht, Utrecht, The Netherlands. mbonten{at}

  • Source of funding: Praevention Foundation.