Journal of Critical Care
Volume 24, Issue 4 , Pages 515-522 , December 2009

Impact of patient position on the incidence of ventilator-associated pneumonia: A meta-analysis of randomized controlled trials

  • Vangelis G. Alexiou, MD

      Affiliations

    • Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
  • ,
  • Vrettos Ierodiakonou, MD

      Affiliations

    • Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
  • ,
  • George Dimopoulos, MD, PhD, FCCP

      Affiliations

    • Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
    • Department of Intensive Care, University Hospital “ATTIKON”, Medical School, University of Athens, Athens, Greece
  • ,
  • Matthew E. Falagas, MD, MSc, DSc

      Affiliations

    • Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
    • Department of Medicine, Henry Dunant Hospital, Athens, Greece
    • Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
    • Corresponding Author InformationCorresponding author. Alfa Institute of Biomedical Sciences (AIBS), 151 23 Marousi, Greece. Tel.: +30 694 61 10 000; fax: +30 210 68 39 605.

References 

  1. Johanson WG, Woods DE, Chaudhuri T. Association of respiratory tract colonization with adherence of gram-negative bacilli to epithelial cells. J Infect Dis. 1979;139:667–673
  2. Johanson WG, Pierce AK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med. 1972;77:701–706
  3. Bonten MJ, Gaillard CA, de Leeuw PW, Stobberingh EE. Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia. Clin Infect Dis. 1997;24:309–319
  4. Ibáñez J, Peñafiel A, Raurich JM, Marse P, Jordá R, Mata F. Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions. J Parenter Enteral Nutr. 1992;16:419–422
  5. Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992;116:540–543
  6. Centers for Disease Control and Prevention . Guidelines for prevention of nosocomial pneumonia. MMWR Morb Mortal Wkly Rep. 1997;46:1–79
  7. Cook DJ, Meade MO, Hand LE, McMullin JP. Toward understanding evidence uptake: semirecumbency for pneumonia prevention. Crit Care Med. 2002;30:1472–1477
  8. Combes A. Backrest elevation for the prevention of ventilator-associated pneumonia: back to the real world?. Crit Care Med. 2006;34:559–561
  9. Harcombe CJ. Nursing patients with ARDS in the prone position. Nurs Stand. 2004;18:33–39
  10. McCormick J, Blackwood B. Nursing the ARDS patient in the prone position: the experience of qualified ICU nurses. Intensive Crit Care Nurs. 2001;17:331–340
  11. Ball C, Adams J, Boyce S, Robinson P. Clinical guidelines for the use of the prone position in acute respiratory distress syndrome. Intensive Crit Care Nurs. 2001;17:94–104
  12. Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004;292:2379–2387
  13. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Lancet. 1999;354:1896–1900
  14. Grossman RF, Fein A. Evidence-based assessment of diagnostic tests for ventilator-associated pneumonia. Executive summary. Chest. 2000;117:177S–181S
  15. 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
  16. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354:1851–1858
  17. Keeley L. Reducing the risk of ventilator-acquired pneumonia through head of bed elevation. Nurs Crit Care. 2007;12:287–294
  18. Voggenreiter G, Aufmkolk M, Stiletto RJ, et al. Prone positioning improves oxygenation in post-traumatic lung injury—a prospective randomized trial. J Trauma. 2005;59:333–341discussion 341-3
  19. Mancebo J, Fernandez R, Blanch L, et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;173:1233–1239
  20. Beuret P, Carton MJ, Nourdine K, Kaaki M, Tramoni G, Ducreux JC. Prone position as prevention of lung injury in comatose patients: a prospective, randomized, controlled study. Intensive Care Med. 2002;28:564–569
  21. Beuret P. Prone position for the prevention of lung infection. Minerva Anestesiol. 2002;68:266–268
  22. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560
  23. Gattinoni L, Tognoni G, Pesenti A, et al. Prone-Supine Study Group. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;345:568–573
  24. Siempos II, Vardakas KZ, Kopterides P, Falagas ME. Impact of passive humidification on clinical outcomes of mechanically ventilated patients: a meta-analysis of randomized controlled trials. Crit Care Med. 2007;35:2843–2851
  25. Siempos II, Vardakas KZ, Falagas ME. Closed tracheal suction systems for prevention of ventilator-associated pneumonia. Br J Anaesth. 2008;[in press]
  26. Siempos II, Falagas ME. Oral decontamination with chlorhexidine reduces the incidence of nosocomial pneumonia. Crit Care. 2007;11:402
  27. Fernandez R, Trenchs X, Klamburg J, et al. Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial. Intensive Care Med. 2008;34:1487–1491
  28. The American Thoracic Society and the Infectious Diseases Society of America Guideline Committee . Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416
  29. Dodek P, Keenan S, Cook D, et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med. 2004;141:305–403

PII: S0883-9441(08)00204-9

doi: 10.1016/j.jcrc.2008.09.003

Journal of Critical Care
Volume 24, Issue 4 , Pages 515-522 , December 2009