title: Semi-recumbent body position fails to prevent healthcare-associated pneumonia in Vietnamese patients with severe tetanus.
abstract: Healthcare-associated pneumonia (HCAP) is a common complication in patients with severe tetanus. Nursing tetanus patients in a semi-recumbent body position could reduce the incidence of HCAP. In a randomised controlled trial we compared the occurrence of HCAP in patients with severe tetanus nursed in a semi-recumbent (30°) or supine position. A total of 229 adults and children (aged ≥1 year) with severe tetanus admitted to hospital in Vietnam, were randomly assigned to a supine (n=112) or semi-recumbent (n=117) position. For patients maintaining their assigned positions and in hospital for>48h there was no significant difference between the two groups in the frequency of clinically suspected pneumonia [22/106 (20.8%) vs 26/104 (25.0%); p=0.464], pneumonia rate/1000 intensive care unit days (13.9 vs 14.6; p=0.48) and pneumonia rate/1000 ventilated days (39.2 vs 38.1; p=0.72). Mortality in the supine patients was 11/112 (9.8%) compared with 17/117 (14.5%) in the semi-recumbent patients (p=0.277). The overall complication rate [57/112 (50.9%) vs 76/117 (65.0%); p=0.03] and need for tracheostomy [51/112 (45.5%) vs 69/117 (58.9%); p=0.04) was greater in semi-recumbent patients. Semi-recumbent body positioning did not prevent the occurrence of HCAP in severe tetanus patients.
authors.affiliation: Hospital for Tropical Diseases, 190 Ben Ham Tu, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Huynh Thi
authors.initials: HT
authors.lastname: Loan
authors.forename: Janet
authors.initials: J
authors.lastname: Parry
authors.forename: Nguyen Thi Ngoc
authors.initials: NT
authors.lastname: Nga
authors.forename: Lam Minh
authors.initials: LM
authors.lastname: Yen
authors.forename: Nguyen Thien
authors.initials: NT
authors.lastname: Binh
authors.forename: Tran Thi Diem
authors.initials: TT
authors.lastname: Thuy
authors.forename: Nguyen Minh
authors.initials: NM
authors.lastname: Duong
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.forename: Louise
authors.initials: L
authors.lastname: Thwaites
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D012121:Respiration, Artificial; D013742:Tetanus / Q000150:complications*; D014139:Tracheostomy; D017211:Treatment Failure; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult