![]() 1 The semirecumbent position may decrease nosocomial pneumonia by decreasing gastro-oesophageal reflux, abnormal oropharyngeal colonisation, and aspiration of gastric contents to lower airways. Gastro-oesophageal reflux is a consistent finding in mechanically ventilated patients and may favour pneumonia by promoting retrograde oropharyngeal colonisation and aspiration to lower airways. The frequency of clinically suspected pneumonia was 50% when patients were enterally fed in the supine position, 9% when enterally fed in the semirecumbent position, 10% when not enterally fed but in the supine position, and 6% when not enterally fed but in the semirecumbent position (p<0.001). Multivariate analysis showed that nosocomial pneumonia was associated with enteral nutrition and supine body position. This trial is unique because rather than examining surrogate outcomes for pneumonia, the authors examined clinically suspected and microbiologically confirmed cases of nosocomial pneumonia. Patients who were cared for in this position had a more than 75% reduction in the rate of nosocomial pneumonia when compared with patients in a supine position. Drakulovic et al have shown that in the absence of contraindications, the semirecumbent position is an affordable, feasible, and effective strategy to reduce the risk of nosocomial pneumonia in patients who are mechanically ventilated, especially when patients are receiving continuous enteral feeding through a nasogastric tube.
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