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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
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Ventilator-associated pneumonia: role of positioning
Gianluigi Li Bassi1, Antoni Torres
1Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Barcelona, Spain.
Current Opinion in Critical Care
|December 21, 2010
Summary
Avoiding the supine horizontal position is crucial for preventing ventilator-associated pneumonia (VAP). While the semirecumbent position shows benefits, novel body positions are needed to further reduce VAP risks in intubated patients.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Diseases
Background:
- Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in intubated patients.
- Body positioning significantly influences VAP pathogenesis, including aspiration and secretion clearance.
- Current strategies focus on head-of-bed elevation and patient positioning.
Purpose of the Study:
- To review the efficacy of supine semirecumbent and prone positions in VAP prevention.
- To highlight the impact of body position on VAP risk factors.
- To explore potential novel body positions for VAP reduction.
Main Methods:
- Systematic review of recent literature on VAP prevention strategies.
- Analysis of studies evaluating semirecumbent, supine, and prone positions.
- Examination of laboratory findings on airway axis and secretion drainage.
Main Results:
- Recent studies question the benefit of semirecumbent position above 30° head elevation.
- Supine horizontal position increases aspiration and VAP risk, especially with enteral feeding.
- Prone position aids secretion drainage but has adverse effects limiting its use.
- Maintaining an endotracheal tube-oropharynx-trachea axis below horizontal is key.
Conclusions:
- Avoidance of the supine horizontal position is recommended to prevent aspiration.
- Routine use of the semirecumbent position is beneficial, though optimal angle requires further study.
- Novel positions like the lateral Trendelenburg may reduce aspiration and improve mucus clearance.
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