Semi-recumbent position reduces the risk of clinically suspected VAP in patients on mechanical ventilation, compared to a supine position

Added March 24, 2020

Citation: Wang L, Li X, Yang Z, et al. Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database of Systematic Reviews 2016; (1): CD009946 

What is this? Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU), but this can cause complications, including ventilator-associated pneumonia (VAP). A semi-recumbent position (also known as “head bed elevation”) may prevent VAP in comparison to a supine position.

In this Cochrane systematic review, the authors included randomized trials that compared semi-recumbent versus supine positioning, or alternative degrees of positioning, in patients on MV.  They did not restrict by date, type or language of publication and did their searches in October 2015. They identified 10 trials (878 participants).

What works: A semi-recumbent position (30-60 degrees) reduces the risk of clinically suspected VAP in patients on MV, when compared to a supine position (0-10 degrees).

What doesn’t work: Nothing noted.

What’s uncertain: The comparative effects of the different positions are uncertain for outcomes other than clinically suspected VAP.


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