37th International Symposium on Intensive Care and Emergency Medicine (part 1 of 3)

Abstract

Introduction: The semi‐recumbent position (SRP) could increase risk of gravity‐driven pulmonary aspiration and ventilator‐associated pneumonia (VAP) (1‐2). We investigated whether the lateral‐ Trendelenburg position (LTP) vs. the SRP would prevent microbiologically confirmed VAP. Methods: 194 patients were randomized into the LTP group and 201 in SRP, and analyzed in an intention to treat approach. Patients in LTP were turned from one side to the other every 6 hours. Whereas, in the SRP group, patients were kept with the head of the bed elevated > = 30°. Primary outcome was VAP incidence rate, based on quantitative bronchoalveolar lavage fluid culture. Secondary outcomes were duration of mechanical ventilation, intensive care unit (ICU) and hospital stays, and ICU/hospital/ 28‐day mortality. Results: The data safety monitoring board recommended stopping the study at the second interim analysis for low incidence of VAP in the control group, lack of benefits in any major secondary outcome and adverse events in the LTP group. Microbiologically confirmed VAP was 0.5% (1/194 patients) in patients positioned in LTP, and 4.0% (8/201 patients) in patients in SRP, risk ratio (RR) between groups 0.13, 95% confidence interval (CI) 0.02‐1.03, p = 0.04. Microbiologically confirmed VAP per 1000 ventilator days was 7.19, 95%CI 3.60‐14.37 and 0.88, 95%CI 0.12‐6.25 in the LTP and SRP, respectively, RR 0.12, 95%CI 0.01‐0.91, p = 0.02. Competing risk analysis, which accounted for the concomitant risk of death and discontinuation of MV on VAP, confirmed lower cumulative probability of VAP in the LTP (cause‐specific hazard ratio 0.13, 95% CI 0.02‐1.00, p = 0.05). No statistically significant between‐group differences were observed in secondary outcomes. Conclusions: Critically ill patients positioned in the LTP had a statistically significant reduction in the incidence of VAP, in comparison with the SRP. Yet, further clinical examinations are mandatory to corroborate our findings, specifically in populations at high risk of VAP.