Trial reportIntensive care medicine2017
Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia.
Trial report in Intensive care medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Prospective, Randomized, Multi-Center Trial of Lateral Trendelenburg Versus Semi-Recumbent Body Position in Mechanically Ventilated Patients For The Prevention of Ventilator-Associated Pneumonia
Chinese Adaptive Randomised Pneumonia Trial With Respiratory Failure
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Guideline on positioning and early mobilisation in the critically ill by an expert panel.Intensive care medicine · 2024Guideline
- Positioning for acute respiratory distress in hospitalised infants and children.The Cochrane database of systematic reviews · 2022Pooled it
- Preventing ventilator-associated pneumonia non-pharmacologically.Intensive care medicine · 2024Article
- Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review.Acute and critical care · 2024Article
- Ten Issues to Update in Nosocomial or Hospital-Acquired Pneumonia: An Expert Review.Journal of clinical medicine · 2023Review
- PEEP Titration Is Markedly Affected by Trunk Inclination in Mechanically Ventilated Patients with COVID-19 ARDS: A Physiologic, Cross-Over Study.Journal of clinical medicine · 2023Article
- Severe Acute Cor Pulmonale in Patients with COVID-19 Acute Respiratory Distress Syndrome: Caution with Left Turn.American journal of respiratory and critical care medicine · 2022Article
- Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis.Journal of intensive care · 2022Review
- Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study.Journal of clinical medicine · 2021Article
- The Role of Dysbiosis in Critically Ill Patients With COVID-19 and Acute Respiratory Distress Syndrome.Frontiers in medicine · 2021Review
- Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19.Respiratory physiology & neurobiology · 2020Review
- Predicting ventilator-associated pneumonia.Annals of translational medicine · 2020Article
- Ventilator-associated pneumonia in adults: a narrative review.Intensive care medicine · 2020Review
- The zero-VAP sophistry and controversies surrounding prevention of ventilator-associated pneumonia.Intensive care medicine · 2020Article
- Prevention of Lung Bacterial Colonization With a Leak-Proof Endotracheal Tube Cuff: An Experimental Animal Study.Respiratory care · 2019Article
- Focus on ventilation management.Intensive care medicine · 2018Article
- Appraisal of systemic inflammation and diagnostic markers in a porcine model of VAP: secondary analysis from a study on novel preventive strategies.Intensive care medicine experimental · 2018Article
- Prompt admission to the ICU: an instrument to improve mortality for deteriorating ward patients.Intensive care medicine · 2018Article
- Ventilator-associated pneumonia prevention: one good turn does not always deserve another.Intensive care medicine · 2017Article
- Oral Care and Positioning to Prevent Ventilator-Associated Pneumonia: A Systematic Review.SAGE open nursingReview
Corrections and comments
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Authors and funding
47 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe lateral Trendelenburg position (LTP) may hinder the primary pathophysiologic mechanism of ventilator-associated pneumonia (VAP). We investigated whether placing patients in the LTP would reduce the incidence of VAP in comparison with the semirecumbent position (SRP).
methodsThis was a randomized, multicenter, controlled study in invasively ventilated critically ill patients. Two preplanned interim analyses were performed. Patients were randomized to be placed in the LTP or the SRP. The primary outcome, assessed by intention-to-treat analysis, was incidence of microbiologically confirmed VAP. Major secondary outcomes included mortality, duration of mechanical ventilation, and intensive care unit length of stay.
resultsAt the second interim analysis, the trial was stopped because of low incidence of VAP, lack of benefit in secondary outcomes, and occurrence of adverse events. A total of 194 patients in the LTP group and 201 in the SRP group were included in the final intention-to-treat analysis. The incidence of microbiologically confirmed VAP was 0.5% (1/194) and 4.0% (8/201) in LTP and SRP patients, respectively (relative risk 0.13, 95% CI 0.02-1.03, p = 0.04). The 28-day mortality was 30.9% (60/194) and 26.4% (53/201) in LTP and SRP patients, respectively (relative risk 1.17, 95% CI 0.86-1.60, p = 0.32). Likewise, no differences were found in other secondary outcomes. Six serious adverse events were described in LTP patients (p = 0.01 vs. SRP).
conclusionsThe LTP slightly decreased the incidence of microbiologically confirmed VAP. Nevertheless, given the early termination of the trial, the low incidence of VAP, and the adverse events associated with the LTP, the study failed to prove any significant benefit. Further clinical investigation is strongly warranted; however, at this time, the LTP cannot be recommended as a VAP preventive measure. CLINICALTRIALS. GOV IDENTIFIER: NCT01138540.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.