Semi-recumbent body position fails to prevent healthcare-associated pneumonia in Vietnamese patients with severe tetanus

Huynh Thi Loan, Janet Parry, Nguyen Thi Ngoc Nga, Lam Minh Yen, Nguyen Thien Binh, Tran Thi Diem Thuy, Nguyen Minh Duong, James I Campbell, Louise Thwaites, Jeremy J Farrar, Christopher M Parry, Huynh Thi Loan, Janet Parry, Nguyen Thi Ngoc Nga, Lam Minh Yen, Nguyen Thien Binh, Tran Thi Diem Thuy, Nguyen Minh Duong, James I Campbell, Louise Thwaites, Jeremy J Farrar, Christopher M Parry

Abstract

Healthcare-associated pneumonia (HCAP) is a common complication in patients with severe tetanus. Nursing tetanus patients in a semi-recumbent body position could reduce the incidence of HCAP. In a randomised controlled trial we compared the occurrence of HCAP in patients with severe tetanus nursed in a semi-recumbent (30°) or supine position. A total of 229 adults and children (aged ≥1 year) with severe tetanus admitted to hospital in Vietnam, were randomly assigned to a supine (n=112) or semi-recumbent (n=117) position. For patients maintaining their assigned positions and in hospital for>48h there was no significant difference between the two groups in the frequency of clinically suspected pneumonia [22/106 (20.8%) vs 26/104 (25.0%); p=0.464], pneumonia rate/1000 intensive care unit days (13.9 vs 14.6; p=0.48) and pneumonia rate/1000 ventilated days (39.2 vs 38.1; p=0.72). Mortality in the supine patients was 11/112 (9.8%) compared with 17/117 (14.5%) in the semi-recumbent patients (p=0.277). The overall complication rate [57/112 (50.9%) vs 76/117 (65.0%); p=0.03] and need for tracheostomy [51/112 (45.5%) vs 69/117 (58.9%); p=0.04) was greater in semi-recumbent patients. Semi-recumbent body positioning did not prevent the occurrence of HCAP in severe tetanus patients.

Trial registration: ClinicalTrials.gov NCT01331252.

Copyright © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
CONSORT flow chart demonstrating recruitment of patients to the study. HCAP: healthcare-associated pneumonia; ICU: intensive care unit.

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Source: PubMed

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