Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: A randomized study
CONTEXT:Reducing aspiration of gastric contents by placing mechanically ventilated patients in a semirecumbent position has been associated with lower incidences of ventilator-associated pneumonia (VAP). The feasibility and efficacy of this intervention in a larger patient population, however, are u...
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| Veröffentlicht in: | Critical care medicine 2006-02, Vol.34 (2), p.396-402 |
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| creator | van Nieuwenhoven, Christianne A Vandenbroucke-Grauls, Christine van Tiel, Frank H Joore, Hans C. A van Schijndel, Rob J. M. Strack van der Tweel, Ingeborg Ramsay, Graham Bonten, Marc J. M |
| description | CONTEXT:Reducing aspiration of gastric contents by placing mechanically ventilated patients in a semirecumbent position has been associated with lower incidences of ventilator-associated pneumonia (VAP). The feasibility and efficacy of this intervention in a larger patient population, however, are unknown.
OBJECTIVE:Assessment of the feasibility of the semirecumbent position for intensive care unit patients and its influence on development of VAP.
DESIGN:In a prospective multicentered trial, critically ill patients undergoing mechanical ventilation were randomly assigned to the semirecumbent position, with a target backrest elevation of 45°, or standard care (i.e., supine position) with a backrest elevation of 10°.
MAIN OUTCOME MEASURES:Backrest elevation was measured continuously during the first week of ventilation with a monitor-linked device. A deviation of position was defined as a change of the randomized position >5°. Diagnosis of VAP was made by quantitative cultures of samples obtained by bronchoscopic techniques.
RESULTS:One hundred nine patients were assigned to the supine group and 112 to the semirecumbent group. Baseline characteristics were comparable for both groups. Average elevations were 9.8° and 16.1° at day 1 and day 7, respectively, for the supine group and 28.1° and 22.6° at day 1 and day 7, respectively, for the semirecumbent group (p < .001). The target semirecumbent position of 45° was not achieved for 85% of the study time, and these patients more frequently changed position than supine-positioned patients. VAP was diagnosed in eight patients (6.5%) in the supine group and in 13 (10.7%) in the semirecumbent group (NS), after a mean of 6 (range, 3–9) and 7 (range, 3–12) days, respectively. There were no differences in numbers of patients undergoing enteral feeding, receiving stress ulcer prophylaxis, or developing pressure sores or in mortality rates or duration of ventilation and intensive care unit stay between the groups.
CONCLUSIONS:The targeted backrest elevation of 45° for semirecumbent positioning was not reached in the conditions of the present randomized study. The achieved difference in treatment position (28° vs. 10°) did not prevent the development of VAP. |
| doi_str_mv | 10.1097/01.CCM.0000198529.76602.5E |
| format | Article |
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OBJECTIVE:Assessment of the feasibility of the semirecumbent position for intensive care unit patients and its influence on development of VAP.
DESIGN:In a prospective multicentered trial, critically ill patients undergoing mechanical ventilation were randomly assigned to the semirecumbent position, with a target backrest elevation of 45°, or standard care (i.e., supine position) with a backrest elevation of 10°.
MAIN OUTCOME MEASURES:Backrest elevation was measured continuously during the first week of ventilation with a monitor-linked device. A deviation of position was defined as a change of the randomized position >5°. Diagnosis of VAP was made by quantitative cultures of samples obtained by bronchoscopic techniques.
RESULTS:One hundred nine patients were assigned to the supine group and 112 to the semirecumbent group. Baseline characteristics were comparable for both groups. Average elevations were 9.8° and 16.1° at day 1 and day 7, respectively, for the supine group and 28.1° and 22.6° at day 1 and day 7, respectively, for the semirecumbent group (p < .001). The target semirecumbent position of 45° was not achieved for 85% of the study time, and these patients more frequently changed position than supine-positioned patients. VAP was diagnosed in eight patients (6.5%) in the supine group and in 13 (10.7%) in the semirecumbent group (NS), after a mean of 6 (range, 3–9) and 7 (range, 3–12) days, respectively. There were no differences in numbers of patients undergoing enteral feeding, receiving stress ulcer prophylaxis, or developing pressure sores or in mortality rates or duration of ventilation and intensive care unit stay between the groups.
CONCLUSIONS:The targeted backrest elevation of 45° for semirecumbent positioning was not reached in the conditions of the present randomized study. The achieved difference in treatment position (28° vs. 10°) did not prevent the development of VAP.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000198529.76602.5E</identifier><identifier>PMID: 16424720</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; APACHE ; Biological and medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Critical Care - methods ; Emergency and intensive respiratory care ; Feasibility Studies ; Female ; Hospital Mortality ; Humans ; Intensive care medicine ; Intensive Care Units ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Pneumonia - etiology ; Pneumonia - prevention & control ; Respiration, Artificial - adverse effects ; Supine Position</subject><ispartof>Critical care medicine, 2006-02, Vol.34 (2), p.396-402</ispartof><rights>2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4587-b30456cbeca44341a3c41e1aa67bb782f7fff710d45cebda68bca0edbe26043a3</citedby><cites>FETCH-LOGICAL-c4587-b30456cbeca44341a3c41e1aa67bb782f7fff710d45cebda68bca0edbe26043a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17474536$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16424720$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Nieuwenhoven, Christianne A</creatorcontrib><creatorcontrib>Vandenbroucke-Grauls, Christine</creatorcontrib><creatorcontrib>van Tiel, Frank H</creatorcontrib><creatorcontrib>Joore, Hans C. A</creatorcontrib><creatorcontrib>van Schijndel, Rob J. M. Strack</creatorcontrib><creatorcontrib>van der Tweel, Ingeborg</creatorcontrib><creatorcontrib>Ramsay, Graham</creatorcontrib><creatorcontrib>Bonten, Marc J. M</creatorcontrib><title>Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: A randomized study</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>CONTEXT:Reducing aspiration of gastric contents by placing mechanically ventilated patients in a semirecumbent position has been associated with lower incidences of ventilator-associated pneumonia (VAP). The feasibility and efficacy of this intervention in a larger patient population, however, are unknown.
OBJECTIVE:Assessment of the feasibility of the semirecumbent position for intensive care unit patients and its influence on development of VAP.
DESIGN:In a prospective multicentered trial, critically ill patients undergoing mechanical ventilation were randomly assigned to the semirecumbent position, with a target backrest elevation of 45°, or standard care (i.e., supine position) with a backrest elevation of 10°.
MAIN OUTCOME MEASURES:Backrest elevation was measured continuously during the first week of ventilation with a monitor-linked device. A deviation of position was defined as a change of the randomized position >5°. Diagnosis of VAP was made by quantitative cultures of samples obtained by bronchoscopic techniques.
RESULTS:One hundred nine patients were assigned to the supine group and 112 to the semirecumbent group. Baseline characteristics were comparable for both groups. Average elevations were 9.8° and 16.1° at day 1 and day 7, respectively, for the supine group and 28.1° and 22.6° at day 1 and day 7, respectively, for the semirecumbent group (p < .001). The target semirecumbent position of 45° was not achieved for 85% of the study time, and these patients more frequently changed position than supine-positioned patients. VAP was diagnosed in eight patients (6.5%) in the supine group and in 13 (10.7%) in the semirecumbent group (NS), after a mean of 6 (range, 3–9) and 7 (range, 3–12) days, respectively. There were no differences in numbers of patients undergoing enteral feeding, receiving stress ulcer prophylaxis, or developing pressure sores or in mortality rates or duration of ventilation and intensive care unit stay between the groups.
CONCLUSIONS:The targeted backrest elevation of 45° for semirecumbent positioning was not reached in the conditions of the present randomized study. The achieved difference in treatment position (28° vs. 10°) did not prevent the development of VAP.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>APACHE</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Critical Care - methods</subject><subject>Emergency and intensive respiratory care</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Pneumonia - etiology</subject><subject>Pneumonia - prevention & control</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Supine Position</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1v1DAQhiMEotvCX0AWEtwS7Pgr6a1abSlSERc4W7Yz1hqSONhOq-XX4-2utD7YmtEz81pPVX0kuCG4l18wabbb7w0uh_Qdb_tGCoHbhu9eVRvCKa5x29PX1QbjHteU9fSquk7pd8EZl_RtdUUEa5ls8abK96CTN370-YD0PCBwDmxOKDiU94ASTD6CXScDc0ZLSD77MKMc0BLh6dg7Xn7UOcRapxSs1xkGtMywTmH2-hbdoVgWh8n_K_2U1-Hwrnrj9Jjg_fm9qX7d735uH-rHH1-_be8ea8t4J2tDMePCGrCaMcqIppYRIFoLaYzsWiedc5LggXELZtCiM1ZjGAy0AjOq6U31-bR3ieHvCimryScL46hnCGtSEouO8b4r4O0JtDGkFMGpJfpJx4MiWB2dK0xUca4uztWLc8V3ZfjDOWU1EwyX0bPkAnw6AzpZPbqiw_p04SSTjFNROHbinsOYIaY_4_oMUe1Bj3n_Ek1bJuoW45Jcqvr4GUn_A1GDnWI</recordid><startdate>200602</startdate><enddate>200602</enddate><creator>van Nieuwenhoven, Christianne A</creator><creator>Vandenbroucke-Grauls, Christine</creator><creator>van Tiel, Frank H</creator><creator>Joore, Hans C. A</creator><creator>van Schijndel, Rob J. M. Strack</creator><creator>van der Tweel, Ingeborg</creator><creator>Ramsay, Graham</creator><creator>Bonten, Marc J. M</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200602</creationdate><title>Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: A randomized study</title><author>van Nieuwenhoven, Christianne A ; Vandenbroucke-Grauls, Christine ; van Tiel, Frank H ; Joore, Hans C. A ; van Schijndel, Rob J. M. Strack ; van der Tweel, Ingeborg ; Ramsay, Graham ; Bonten, Marc J. M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4587-b30456cbeca44341a3c41e1aa67bb782f7fff710d45cebda68bca0edbe26043a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>APACHE</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Critical Care - methods</topic><topic>Emergency and intensive respiratory care</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Pneumonia - etiology</topic><topic>Pneumonia - prevention & control</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Supine Position</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Nieuwenhoven, Christianne A</creatorcontrib><creatorcontrib>Vandenbroucke-Grauls, Christine</creatorcontrib><creatorcontrib>van Tiel, Frank H</creatorcontrib><creatorcontrib>Joore, Hans C. A</creatorcontrib><creatorcontrib>van Schijndel, Rob J. M. Strack</creatorcontrib><creatorcontrib>van der Tweel, Ingeborg</creatorcontrib><creatorcontrib>Ramsay, Graham</creatorcontrib><creatorcontrib>Bonten, Marc J. M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Nieuwenhoven, Christianne A</au><au>Vandenbroucke-Grauls, Christine</au><au>van Tiel, Frank H</au><au>Joore, Hans C. A</au><au>van Schijndel, Rob J. M. Strack</au><au>van der Tweel, Ingeborg</au><au>Ramsay, Graham</au><au>Bonten, Marc J. M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: A randomized study</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2006-02</date><risdate>2006</risdate><volume>34</volume><issue>2</issue><spage>396</spage><epage>402</epage><pages>396-402</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>CONTEXT:Reducing aspiration of gastric contents by placing mechanically ventilated patients in a semirecumbent position has been associated with lower incidences of ventilator-associated pneumonia (VAP). The feasibility and efficacy of this intervention in a larger patient population, however, are unknown.
OBJECTIVE:Assessment of the feasibility of the semirecumbent position for intensive care unit patients and its influence on development of VAP.
DESIGN:In a prospective multicentered trial, critically ill patients undergoing mechanical ventilation were randomly assigned to the semirecumbent position, with a target backrest elevation of 45°, or standard care (i.e., supine position) with a backrest elevation of 10°.
MAIN OUTCOME MEASURES:Backrest elevation was measured continuously during the first week of ventilation with a monitor-linked device. A deviation of position was defined as a change of the randomized position >5°. Diagnosis of VAP was made by quantitative cultures of samples obtained by bronchoscopic techniques.
RESULTS:One hundred nine patients were assigned to the supine group and 112 to the semirecumbent group. Baseline characteristics were comparable for both groups. Average elevations were 9.8° and 16.1° at day 1 and day 7, respectively, for the supine group and 28.1° and 22.6° at day 1 and day 7, respectively, for the semirecumbent group (p < .001). The target semirecumbent position of 45° was not achieved for 85% of the study time, and these patients more frequently changed position than supine-positioned patients. VAP was diagnosed in eight patients (6.5%) in the supine group and in 13 (10.7%) in the semirecumbent group (NS), after a mean of 6 (range, 3–9) and 7 (range, 3–12) days, respectively. There were no differences in numbers of patients undergoing enteral feeding, receiving stress ulcer prophylaxis, or developing pressure sores or in mortality rates or duration of ventilation and intensive care unit stay between the groups.
CONCLUSIONS:The targeted backrest elevation of 45° for semirecumbent positioning was not reached in the conditions of the present randomized study. The achieved difference in treatment position (28° vs. 10°) did not prevent the development of VAP.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>16424720</pmid><doi>10.1097/01.CCM.0000198529.76602.5E</doi><tpages>7</tpages></addata></record> |
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| ispartof | Critical care medicine, 2006-02, Vol.34 (2), p.396-402 |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy APACHE Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Critical Care - methods Emergency and intensive respiratory care Feasibility Studies Female Hospital Mortality Humans Intensive care medicine Intensive Care Units Length of Stay Male Medical sciences Middle Aged Pharmacology. Drug treatments Pneumonia - etiology Pneumonia - prevention & control Respiration, Artificial - adverse effects Supine Position |
| title | Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: A randomized study |
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