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| |  Semirecumbent Body Position Reduces Risk Of Pneumonia In ICU LONDON, UK -- November 26, 1999 -- Pneumonia is the most frequent nosocomial (hospital-acquired) infection among intensive-care unit (ICU) patients. Although controversial, gastric reflux and subsequent aspiration to lower airways could play a part in the pathogenesis of nosocomial pneumonia in these patients who are lying in a supine position for long periods of time and who may be mechanically ventilated. These risk factors may be reduced by putting ICU patients in a semirecumbent body position.
Dr Mitra B. Drakulovic and colleagues from the Clinical Institute of Pneumology and Thoracic Surgery, University of Barcelona, Spain, did a randomised trial to assess whether the incidence of nosocomial pneumonia can be reduced by adopting a semirecumbent body position, and report their findings in this week's issue of The Lancet. Eighty-six mechanically ventilated patients were randomly assigned to semirecumbent (39) or supine (47) body position. The frequency of clinically suspected and microbiologically confirmed nosocomial pneumonia was assessed in both groups. Body position was analysed together with known risk factors for nosocomial pneumonia. Three of 39 patients in the semirecumbent group acquired pneumonia compared with 16 of 47 in the supine group. Supine body position and enteral nutrition (feeding through a tube from the nose to the gut) were independent risk factors for nosocomial pneumonia and the frequency was highest for patients receiving enteral nutrition in the supine body position. The risk of nosocomial pneumonia was also increased by long-duration of mechanical ventilation and decreased consciousness. According to the researchers, "The semirecumbent body position is a low-cost and easy-to-apply measure to reduce the risk of nosocomial pneumonia in mechanically ventilated patients, especially when patients are receiving continuous enteral feeding through a nasogastric tube." Physicians should also be alert to the possibility of pneumonia in patients who are comatose when admitted and who require mechanical ventilation for 7 days or more. In an accompanying commentary (p 1835), Nigel R Webster states: "There seems to be no evidence of harm attributable to the semirecumbent position...Perhaps the question to ask now is whether the nursing of ventilated patients in the supine position is safe and necessary."
Related Link: The Lancet.
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