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Semin Respir Crit Care Med 2017; 38(03): 371-380
DOI: 10.1055/s-0037-1603111
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Body Position and Ventilator-Associated Pneumonia Prevention

Gianluigi Li Bassi
1   Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain
2   University of Barcelona, Barcelona, Spain
3   CIBER Enfermedades Respiratorias (CIBERES), Mallorca, Spain
4   Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
,
Eli Aguilera Xiol
1   Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain
3   CIBER Enfermedades Respiratorias (CIBERES), Mallorca, Spain
,
Francesco Pagliara
1   Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain
5   Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Universita' degli Studi di Genova, Genova, Italy
,
Yang Hua
1   Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain
,
Antoni Torres
1   Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain
2   University of Barcelona, Barcelona, Spain
3   CIBER Enfermedades Respiratorias (CIBERES), Mallorca, Spain
4   Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
04 June 2017 (online)

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Abstract

Seminal studies have demonstrated that tracheally intubated, mechanically ventilated patients, positioned in supine horizontal position, are at a high risk of developing ventilator-associated pneumonia, through aspiration of gastric pathogens. In the 1990s, innovative clinical findings promoted a radical change in practice, through the use of the semirecumbent position in all mechanically ventilated patients. Here, we critically review the main indications, pulmonary effects, and controversies on the use of the semirecumbent position. Also, we will depict potential roles of prone and lateral positions in the prevention of ventilator-associated pneumonia. Our review will span from preclinical experimental insights to clinical evidence, and we will discuss potential controversies on the use of the semirecumbent position as the standard of care. We will also detail potential alternatives to ultimately improve outcomes of tracheally intubated and mechanically ventilated patients.

Keywords

ventilator-associated pneumonia - semirecumbent position - prone position - continuous lateral position - tracheal intubation - critical care
 

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