Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis

Diana P Pozuelo-Carrascosa, Ana Isabel Cobo-Cuenca, Juan Manuel Carmona-Torres, Jose Alberto Laredo-Aguilera, Esmeralda Santacruz-Salas, Ruben Fernandez-Rodriguez, Diana P Pozuelo-Carrascosa, Ana Isabel Cobo-Cuenca, Juan Manuel Carmona-Torres, Jose Alberto Laredo-Aguilera, Esmeralda Santacruz-Salas, Ruben Fernandez-Rodriguez

Abstract

Background: The evidence about the best body position to prevent ventilator-associated pneumonia (VAP) is unclear. The aim of this study was to know what the best body position is to prevent VAP, shorten the length of intensive care unit (ICU) and hospital stay, and reduce mortality among patients undergoing mechanical ventilation (MV).

Methods: We performed a network meta-analysis of randomized controlled trials including intubated patients undergoing MV and admitted to an ICU. The assessed interventions were different body positions (i.e., lateral, prone, semi-recumbent) or alternative degrees of positioning in mechanically ventilated patients.

Results: Semi-recumbent and prone positions showed a risk reduction of VAP incidence (RR: 0.38, 95% CI: 0.25-0.52) and mortality (RR: 0.70, 95% CI: 0.50-0.91), respectively, compared to the supine position. The ranking probabilities and the surface under the cumulative ranking displayed as the first best option of treatment the semi-recumbent position to reduce the incidence of VAP (71.4%), the hospital length of stay (68.9%), and the duration of MV (67.6%); and the prone position to decrease the mortality (89.3%) and to reduce the ICU length of stay (59.3%).

Conclusions: Cautiously, semi-recumbent seems to be the best position to reduce VAP incidence, hospital length of stay and the duration of MV. Prone is the most effective position to reduce the risk of mortality and the ICU length of stay, but it showed no effect on the VAP incidence. Registration PROSPERO CRD42021247547.

Keywords: Body position; Prone; Semi-recumbent; Supine; Ventilator-associated pneumonia.

Conflict of interest statement

The authors declare do not have competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Literature search: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consort diagram
Fig. 2
Fig. 2
Network geometry graphs for changes on ventilator-associated pneumonia, mortality, ICU/hospital length of stay and duration of mechanical ventilation
Fig. 3
Fig. 3
Treatment ranking for each assessed outcome (incidence of ventilator-associated pneumonia, mortality, hospital, and ICU length of stay and duration of mechanical ventilation)

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