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 ventilator-associated 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.
Mauri
Tommaso
T
Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Berra
Lorenzo
L
Kumwilaisak
Kanya
K
Pivi
Silvia
S
Ufberg
Jacob W
JW
Kueppers
Friedrich
F
Pesenti
Antonio
A
Bigatello
Luca M
LM
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000737:chemistry; D056888:Patient Positioning / Q000379:methods*; D010434:Pepsin A / Q000032:analysis; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D011446:Prospective Studies; D012121:Respiration, Artificial; D053120:Respiratory Aspiration / Q000517:prevention & control*; D014132:Trachea / Q000737:chemistry
D010434:Pepsin A