Lateral-horizontal patient position and horizontal orientation of the endotracheal tube to prevent aspiration in adult surgical intensive care unit patients: a feasibility study.
BACKGROUND: Recent data suggest that during mechanical ventilation the lateral-horizontal patient position (in which the endotracheal tube is horizontal) decreases the risk of ventilatorassociated pneumonia, compared to the recommended semi-recumbent position (in which the endotracheal tube slopes d...
| Publicado en: | Respiratory Care Vol. 55; no. 3; pp. 294 - 303 |
|---|---|
| Autores principales: | , , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Mar2010
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105138487&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105138487 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Mar2010 vid: 55 iid: 3 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 105138487 105138487 2010586533 NLM20196878 105138487 ppf: 294 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Lateral-horizontal patient position and horizontal orientation of the endotracheal tube to prevent aspiration in adult surgical intensive care unit patients: a feasibility study. aug: au: Mauri T Berra L Kumwiliasak K Pivi S Ufberg JW Kueppers F Pesenti A Bigatello LM affil: Department of Anesthesia and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail: lbigatello@partners.org sug: subj: Aspiration Prevention and Control Endotracheal Tubes Lateral Position Pneumonia, Ventilator-Associated Prevention and Control Surgical Patients Adult Aged APACHE (Acute Physiology and Chronic Health Evaluation) Chi Square Test Convenience Sample Enteral Nutrition Female Fisher's Exact Test Human Intensive Care Units Male Mann-Whitney U Test Massachusetts Middle Age Nonparametric Statistics Pepsin Analysis Pilot Studies Prospective Studies Secretions Analysis Specimen Handling Suction Wilcoxon Rank Sum Test Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Female Male ab: BACKGROUND: Recent data suggest that during mechanical ventilation the lateral-horizontal patient position (in which the endotracheal tube is horizontal) decreases the risk of ventilatorassociated pneumonia, compared to the recommended semi-recumbent position (in which the endotracheal tube slopes downward into the trachea). We tested the feasibility of the lateral-horizontal patient position, measured the incidence of aspiration of gastric contents, and watched for any adverse effects related to the lateral-horizontal position. METHODS: Ten adult intensive care unit patients were ventilated for 64 hours in the standard semi-recumbent position, and ten for 12- 24 hours in the lateral-horizontal position. Tracheal secretions were collected every 8 hours and every 4 hours, respectively, and tested for pepsin, which is a marker of gastric contents. We also recorded clinical, physiologic, and outcome variables. RESULTS: The patients remained stable during ventilation in the lateral-horizontal position, and no adverse events occurred. Pepsin was detected in the trachea of 7 semi-recumbent patients and in five of the lateral-horizontal patients P = .32). The number of ventilator-free days was 8 days (range 0-21 days) in the semi-recumbent patients, versus 24 days (range 12-25 days) in the lateral-horizontal patients (P = .04). CONCLUSIONS: Implementing the lateral-horizontal position for 12-24 hours in adult intubated intensive care unit patients is feasible, and our patients had no adverse events. The incidence of aspiration of gastric contents in the lateral-horizontal position seems to be similar to that in the semi-recumbent position. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|