背景:关于预防呼吸机相关性肺炎(VAP)的最佳体位的证据尚不清楚。这项研究的目的是了解预防VAP的最佳身体位置,缩短重症监护病房(ICU)和住院时间,并降低机械通气(MV)患者的死亡率。
方法:我们对随机对照试验进行了网络荟萃分析,包括接受MV插管并入住ICU的患者。评估的干预措施是不同的身体位置(即,横向,俯卧,半卧位)或机械通气患者的其他位置。
结果:半卧位和俯卧位显示VAP发生率(RR:0.38,95%CI:0.25-0.52)和死亡率(RR:0.70,95%CI:0.50-0.91)的风险降低,分别,与仰卧位相比。排名概率和表面下的累积排名显示为治疗的第一最佳选择半卧位,以减少VAP的发生率(71.4%),住院时间(68.9%),和MV持续时间(67.6%);俯卧位可以降低死亡率(89.3%)并减少ICU住院时间(59.3%)。
结论:谨慎,半卧位似乎是减少VAP发生率的最佳位置,住院时间和MV的持续时间。俯卧是降低死亡风险和ICU住院时间的最有效位置,但对VAP发病率没有影响。注册PROSPEROCRD42021247547。
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.