Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia
| Autor: | Li Bassi, Gianluigi, for the Gravity-VAP Network, Panigada, Mauro, Ranzani, Otavio T., Zanella, Alberto, Berra, Lorenzo, Cressoni, Massimo, Parrini, Vieri, Kandil, Hassan, Salati, Giovanni, Selvaggi, Paola, Amatu, Alessandro, Sanz-Moncosi, Miquel, Biagioni, Emanuela, Tagliaferri, Fernanda, Furia, Mirella, Mercurio, Giovanna, Costa, Antonietta, Manca, Tullio, Lindau, Simone, Babel, Jaksa, Cavana, Marco, Chiurazzi, Chiara, Marti, Joan-Daniel, Consonni, Dario, Gattinoni, Luciano, Pesenti, Antonio, Wiener-Kronish, Janine, Bruschi, Cecilia, Ballotta, Andrea, Salsi, Pierpaolo, Livigni, Sergio, Iotti, Giorgio, Fernandez, Javier, Girardis, Massimo, Barbagallo, Maria, Moise, Gabriella, Antonelli, Massimo, Caspani, Maria Luisa, Vezzani, Antonella, Meybohm, Patrick, Gasparovic, Vladimir, Geat, Edoardo, Amato, Marcelo, Niederman, Michael, Kolobow, Theodor, Torres, Antoni |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Critical Care medicine.medical_treatment Trendelenburg position Critical Care and Intensive Care Medicine Patient Positioning law.invention Head-Down Tilt 03 medical and health sciences Endotracheal intubation Mechanical ventilation Semirecumbent position Ventilator-associated pneumonia 0302 clinical medicine law Multicenter trial medicine Humans 030212 general & internal medicine Aged business.industry Incidence Incidence (epidemiology) Pneumonia Ventilator-Associated Middle Aged medicine.disease Interim analysis Respiration Artificial Intensive care unit Intention to Treat Analysis 030228 respiratory system Anesthesia Relative risk Female business |
| Zdroj: | Intensive Care Medicine. 43:1572-1584 |
| ISSN: | 1432-1238 0342-4642 |
| Popis: | Purpose: The lateral Trendelenburg position (LTP) may hinder the primary pathophysiologic mechanism of ventilator-associated pneumonia (VAP). We investigated whether placing patients in the LTP would reduce the incidence of VAP in comparison with the semirecumbent position (SRP). Methods: This was a randomized, multicenter, controlled study in invasively ventilated critically ill patients. Two preplanned interim analyses were performed. Patients were randomized to be placed in the LTP or the SRP. The primary outcome, assessed by intention-to-treat analysis, was incidence of microbiologically confirmed VAP. Major secondary outcomes included mortality, duration of mechanical ventilation, and intensive care unit length of stay. Results: At the second interim analysis, the trial was stopped because of low incidence of VAP, lack of benefit in secondary outcomes, and occurrence of adverse events. A total of 194 patients in the LTP group and 201 in the SRP group were included in the final intention-to- treat analysis. The incidence of microbiologically confirmed VAP was 0.5% (1/194) and 4.0% (8/201) in LTP and SRP patients, respectively (relative risk 0.13, 95% CI 0.02- 1.03, p = 0.04). The 28-day mortality was 30.9% (60/194) and 26.4% (53/201) in LTP and SRP patients, respectively (relative risk 1.17, 95% CI 0.86-1.60, p = 0.32). Likewise, no differences were found in other secondary outcomes. Six serious adverse events were described in LTP patients (p = 0.01 vs. SRP). Conclusions: The LTP slightly decreased the incidence of microbiologically confirmed VAP. Nevertheless, given the early termination of the trial, the low incidence of VAP, and the adverse events associated with the LTP, the study failed to prove any significant benefit. Further clinical investigation is strongly warranted ; however, at this time, the LTP cannot be recommended as a VAP preventive measure. CLINICALTRIALS. |
| Databáze: | OpenAIRE |
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