Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia

Bassi, Gianluigi Li; Panigada, Mauro; Ranzani, Otávio 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, G; Costa, Antonietta; Manca, Tullio; Lindau, Simone; Babel, Jakša; Cavana, Marco; Chiurazzi, Chiara; Martí, Joan Daniel; Consonni, Dario; Gattinoni, Luciano; Pesenti, Antonio; Wiener-Kronish, J. P.; Bruschi, Cecilia; Ballotta, Andrea; Salsi, Pierpaolo; Livigni, Sergio; Iotti, Giorgio; Fernández, Javier; Girardis, Massimo; Barbagallo, M; Moise, G; Antonelli, Massimo; Caspani, Maria Luisa; Vezzani, Antonella; Meybohm, Patrick; Gašparović, Vladimir; Geat, Edoardo; Amato, M; Niederman, Michael S.; Kolobow, Theodor; Torres, Antoni

doi:10.1007/s00134-017-4858-1

Cited by 42 publications

(29 citation statements)

References 37 publications

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“…Some investigators have hypothesized that putting patients in the lateral Trendelenburg may be a better way to prevent VAP by recruiting gravity to carry oral secretions away from the lungs. A recent study confirmed this hypothesis, but the trial was terminated early due to a surfeit of adverse events among patients randomized to lateral Trendelenburg [117].…”

Section: In Intubated Patients Suspected Of Having Vap Should Distalmentioning

confidence: 99%

Ventilator-associated pneumonia in adults: a narrative review

Papazian¹,

2020

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Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections. Reported incidences vary widely from 5 to 40% depending on the setting and diagnostic criteria. VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated attributable mortality of VAP is around 10%, with higher mortality rates in surgical ICU patients and in patients with mid-range severity scores at admission. Microbiological confirmation of infection is strongly encouraged. Which sampling method to use is still a matter of controversy. Emerging microbiological tools will likely modify our routine approach to diagnosing and treating VAP in the next future. Prevention of VAP is based on minimizing the exposure to mechanical ventilation and encouraging early liberation. Bundles that combine multiple prevention strategies may improve outcomes, but large randomized trials are needed to confirm this. Treatment should be limited to 7 days in the vast majority of the cases. Patients should be reassessed daily to confirm ongoing suspicion of disease, antibiotics should be narrowed as soon as antibiotic susceptibility results are available, and clinicians should consider stopping antibiotics if cultures are negative.

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Section: In Intubated Patients Suspected Of Having Vap Should Distalmentioning

confidence: 99%

Ventilator-associated pneumonia in adults: a narrative review

Papazian¹,

2020

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“…Positioning the patient with the head of the bed elevated > 30° reduces aspiration and clinically confirmed VAP [15], but quality of evidence supporting this intervention is poor, and the optimal angulation of the head of the bed is still uncertain. The Gravity-VAP trial showed that the lateral-Trendelenburg position (LTP) could further reduce VAP, specifically in patients with healthy lungs upon intubation, but LTP feasibility appeared challenging [16]. To date, only ETTs comprising aspiration of subglottic secretions [17] reduced VAP by more than 50%, but substantial benefits were mostly corroborated in cardiac surgery patients.…”

Section: Non-pharmacological Measuresmentioning

confidence: 99%

The zero-VAP sophistry and controversies surrounding prevention of ventilator-associated pneumonia

2019

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“…Kombine grupta diğer 2 deney grubundan daha düşük oranda VİP görülmesi nedeniyle subglottik salgı drenajı ve semirekümbent pozisyon kombinasyonu VİP insidansını azaltabileceği saptanmıştır (19). Bassi ve arkadaşları (2017) tarafından yürütülen çalışmada VİP insidansı semirekümbent pozisyona kıyasla yan trendelenburg pozisyonunda daha düşük bulunmuştur (77). Wang ve arkadaşları (2014) gerçekleştirdikleri çalışma sonucunda gastrik motilite uyarıcı madde uygulaması ve hastalara semirekümbent pozisyon verilmesi , VİP' in önlenmesinde etkili olduğunu saptamışlardır (55).…”

Section: çAlışmalardan Elde Edilen Bulgularunclassified