The outcomes evaluated were clinically suspected VAP, microbiologically confirmed VAP, ICU mortality, hospital mortality, length of ICU stay, length of hospital stay, duration of mechanical ventilation, antibiotic use and any adverse events. They included only randomised clinical trials comparing semi-recumbent versus supine position (up to 10º) or other degrees of positioning.
(3), conducted a meta-analysis to evaluate the effectiveness and safety of semi-recumbent positioning versus supine positioning to prevent VAP in adults requiring mechanical ventilation. (2), intended to make a more individualised recommendation on positioning, but they could only conclude that “the recommendation should not be compelling, because the prevention of VAP is uncertain and the balance between benefits and harms is unknown… The experts recommend to elevate the head of bed the bed of mechanically ventilated patients to a 20 to 45º position and preferably in >30º position as long as it does not pose risks and conflicts with other nursing tasks, medical interventions or with patients’ wishes”. Semi-recumbent position is the elevation of the head-of-bed to 30-45º and it is recommended for the prevention of ventilator-associated pneumonia (VAP) with almost no absolute contraindications (1). Theoretically, it is applied in most or all intensive care units (ICUs) and it is considered a “standard of care” due to its advantages of being both convenient to implement and cost-free.
0 kommentar(er)
