Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis

Abstract

Background The evidence about the best body position to prevent ventilator-associated pneumonia (VAP) is unclear. The aim of this study was to know what the best body position is to prevent VAP, shorten the length of intensive care unit (ICU) and hospital stay, and reduce mortality among patients undergoing mechanical ventilation (MV). Methods We performed a network meta-analysis of randomized controlled trials including intubated patients undergoing MV and admitted to an ICU. The assessed interventions were different body positions (i.e., lateral, prone, semi-recumbent) or alternative degrees of positioning in mechanically ventilated patients. Results Semi-recumbent and prone positions showed a risk reduction of VAP incidence (RR: 0.38, 95% CI: 0.25–0.52) and mortality (RR: 0.70, 95% CI: 0.50–0.91), respectively, compared to the supine position. The ranking probabilities and the surface under the cumulative ranking displayed as the first best option of treatment the semi-recumbent position to reduce the incidence of VAP (71.4%), the hospital length of stay (68.9%), and the duration of MV (67.6%); and the prone position to decrease the mortality (89.3%) and to reduce the ICU length of stay (59.3%). Conclusions Cautiously, semi-recumbent seems to be the best position to reduce VAP incidence, hospital length of stay and the duration of MV. Prone is the most effective position to reduce the risk of mortality and the ICU length of stay, but it showed no effect on the VAP incidence. Registration PROSPERO CRD42021247547

Experience of Nurses in the Prevention of Ventilator-Associated Pneumonia Among Critically Ill Patients at Muhimbili National Hospital in Dar es Salaam

“…This suggests that nurses are not updated on the VAP bundle therefore, this hinders the provision of quality care. our ndings are similar to studies conducted in the Philippines, Italy, and Nepal which revealed that there was a lack of formal training on the components of VAP prevention strategies (20,25,27).…”

Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

“…We hypothesise that the prone position might facilitate the dissemination of microorganisms to the lower respiratory tract 37 – 39 , leading to a greater risk for VAP development. Nonetheless, a 2022 systematic review and network meta-analysis including 20 randomised clinical trials state that the prone position did not increase the VAP incidence 40 . Thus, more studies are required to understand this finding further.…”

Carbapenem-Resistant Klebsiella pneumoniae Among Patients with Ventilator-Associated Pneumonia: Evaluation of Antibiotic Combinations and Susceptibility to New Antibiotics

“…VAP accounts for one-fourth of the infections occurring in critically ill patients and is the reason for half of antibiotic prescriptions in mechanically ventilated patients. 1 CR K. pneumoniae is associated with high morbidity and mortality and is considered a significant public health challenge worldwide.…”

“…Ventilator-associated pneumonia (VAP) is the most serious intensive care unit (ICU)-acquired infection of the lung parenchyma that develops after 48 hours of endotracheal intubation and mechanical ventilation. 1 …”