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

Autor: Pozuelo-Carrascosa DP; Faculty of Physiotherapy and Nursing of Toledo, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, 45005, Toledo, Spain.; Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005, Toledo, Spain.; Health and Social Research Center (CESS), University of Castilla-La Mancha, Cuenca, Spain., Cobo-Cuenca AI; Faculty of Physiotherapy and Nursing of Toledo, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, 45005, Toledo, Spain. anaisabel.cobo@uclm.es.; Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005, Toledo, Spain. anaisabel.cobo@uclm.es.; Maimónides Biomedical Research Instituto of Córdoba (IMIBIC), 14004, Córdoba, Spain. anaisabel.cobo@uclm.es., Carmona-Torres JM; Faculty of Physiotherapy and Nursing of Toledo, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, 45005, Toledo, Spain.; Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005, Toledo, Spain.; Maimónides Biomedical Research Instituto of Córdoba (IMIBIC), 14004, Córdoba, Spain., Laredo-Aguilera JA; Faculty of Physiotherapy and Nursing of Toledo, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, 45005, Toledo, Spain.; Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005, Toledo, Spain.; Maimónides Biomedical Research Instituto of Córdoba (IMIBIC), 14004, Córdoba, Spain., Santacruz-Salas E; Faculty of Physiotherapy and Nursing of Toledo, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, 45005, Toledo, Spain.; Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005, Toledo, Spain., Fernandez-Rodriguez R; Health and Social Research Center (CESS), University of Castilla-La Mancha, Cuenca, Spain.
Jazyk: angličtina
Zdroj: Journal of intensive care [J Intensive Care] 2022 Feb 22; Vol. 10 (1), pp. 9. Date of Electronic Publication: 2022 Feb 22.
DOI: 10.1186/s40560-022-00600-z
Abstrakt: 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.
(© 2022. The Author(s).)
Databáze: MEDLINE
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