Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients:: a randomised trial
Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients:: a randomised trial
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DOI：
10.1016/s0140-6736(98)12251-1
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发表时间：
1999-11-27
期刊：
影响因子：
168.9
通讯作者：
Ferrer, N
中科院分区：
文献类型：
--
作者：
Drakulovic, MB;Torres, A;Ferrer, N
背景重症监护患者采用半卧位体位可以降低院内获得性肺炎的危险因素，如胃食管反流和随后的误吸。本研究的目的是评估是否医院获得性肺炎的发病率也可以减少由ESTA measure.Methods本试验停止后，计划的中期analysis.86插管和机械通气患者的一个医疗和一个呼吸重症监护病房在三级保健大学医院被随机分配到半卧位（n=39）或仰卧位（n=47）体位。在两组中评估临床疑似和微生物学证实的医院获得性肺炎（临床加定量细菌学标准）的频率。体位与已知的医院获得性肺炎的危险因素一起进行分析。结果临床疑似医院获得性肺炎的发生率在半卧位组低于仰卧位组（39例中有3例[8%] vs 47例中有16例[34%]; 95%CI差异为10.0-42.0，p=0.003）。微生物学证实的肺炎也是如此（半卧位2/39 [5%] vs仰卧位11/47 [23%]; 4.2-31.8，p=0.018）。仰卧位（比值比6.8 [1.7-26.7]，p=0.006）和肠内营养（5.7 [1.5-22.8]，p=0.013）是院内获得性肺炎的独立危险因素，仰卧位接受肠内营养的患者发生率最高（14/28，50%）。机械通气7天或更长时间（10.9 [3.0-40.4]，p=0.001）和格拉斯哥昏迷量表评分小于9.Interpretation的额外的危险因素的半卧位的身体位置减少的频率和医院获得性肺炎的风险，特别是在患者接受肠内营养。长期机械通气和意识下降会增加医院获得性肺炎的风险。
Background Risk factors for nosocomial pneumonia, such as gastro-oesophageal reflux and subsequent aspiration, can be reduced by semirecumbent body position in intensive-care patients. The objective of this study was to assess whether the incidence of nosocomial pneumonia can also be reduced by this measure.Methods This trial was stopped after the planned interim analysis, 86 intubated and mechanically ventilated patients of one medical and one respiratory intensive-care unit at a tertiary-care university hospital were randomly assigned to semirecumbent (n=39) or supine (n=47) body position. The frequency of clinically suspected and microbiologically confirmed nosocomial pneumonia (clinical plus quantitative bacteriological criteria) was assessed in both groups. Body position was analysed together with known risk factors for nosocomial pneumonia.Findings The frequency of clinically suspected nosocomial pneumonia was lower in the semirecumbent group than in the supine group (three of 39 [8%] vs 16 of 47 [34%]; 95% CI for difference 10.0-42.0, p=0.003). This was also true for microbiologically confirmed pneumonia (semirecumbent 2/39 [5%] vs supine 11/47 [23%]; 4.2-31.8, p=0.018). Supine body position (odds ratio 6.8 [1.7-26.7], p=0.006) and enteral nutrition (5.7 [1.5-22.8], p=0.013) were independent risk factors for nosocomial pneumonia and the frequency was highest for patients receiving enteral nutrition in the supine body position (14/28, 50%). Mechanical ventilation for 7 days or more (10.9 [3.0-40.4], p=0.001) and a Glasgow coma scale score of less than 9 were additional risk factors.Interpretation The semirecumbent body position reduces frequency and risk of nosocomial pneumonia, especially in patients who receive enteral nutrition. The risk of nosocomial pneumonia is increased by long-duration mechanical ventilation and decreased consciousness.