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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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INFECTIONS  SMART 2002 Milan, May 29-31, 2002

Minerva Anestesiologica 2002 April;68(4):266-8

language: English

Prone position for the prevention of lung infection

Beuret P.

From the Inten­sive ­Care ­Unit, Cen­tre Hos­pi­ta­li­er, ­Roanne, ­France


Pul­mo­nary infec­tion is fre­quent in ­brain ­injured ­patients. It has ­been iden­ti­fied as an inde­pen­dent pre­dic­tor of unfa­vor­able neu­ro­log­i­cal out­come, call­ing for ­attempts of pre­ven­tion. We recent­ly eval­u­at­ed inter­mit­tent ­prone posi­tion­ing for the pre­ven­tion of ven­ti­la­tor-asso­ciat­ed pneu­mo­nia (VAP) in coma­tose ­brain ­injured ­patients, in a ran­dom­ized ­study. 25 ­patients ­were includ­ed in the ­prone posi­tion (PP) ­group: ­they ­were posi­tioned on ­prone ­four ­hours ­once dai­ly ­until ­they ­could get up to sit in an arm­chair; 26 ­patients ­were includ­ed in the ­supine posi­tion (SP) ­group. The ­main char­ac­ter­is­tics of the ­patients ­from the two ­groups ­were sim­i­lar at ran­dom­iza­tion. The pri­mary end-­point was the inci­dence of ­lung wors­en­ing, ­defined by an ­increase in the ­Lung Inju­ry ­Score by at ­least one ­point ­since the ­time of ran­dom­iza­tion. The inci­dence of ­lung wors­en­ing was low­er in the PP ­group (12%) ­than in the SP ­group (50%) (p=0.003). The inci­dence of VAP was 38.4% in the SP ­group and 20% in the PP ­group (p=0.14). ­There was no seri­ous com­pli­ca­tion attrib­ut­able to ­prone posi­tion­ing. In con­clu­sion, the ben­e­fi­cial ­effect of ­prone posi­tion­ing for pre­ven­tion of ­lung infec­tion in ­brain ­injured ­patients is not ­well estab­lished. How­ev­er, in ­those ­patients, ­prone posi­tion­ing is ­able to ­avoid the wors­en­ing of pul­mo­nary func­tion, espe­cial­ly in oxy­gen­a­tion.

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