Semi-recumbent body position fails to prevent healthcare-associated pneumonia in Vietnamese patients with severe tetanus.

Journal article

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: Loan, H; Parry, J; Nga, N; Yen, L; Binh, N

• Publication status: Published
• Journal: Transactions of the Royal Society of Tropical Medicine and Hygiene
• Volume: 106
• Issue: 2
• Pages: 90-97
• Publication date: 2012-02-01
• DOI: 10.1016/j.trstmh.2011.10.010
• EISSN: 1878-3503
• ISSN: 0035-9203
• Language: English
• Keywords: Treatment Failure; Incidence; Tetanus; Intensive Care Units; Vietnam; Patient Positioning; Young Adult; Child; Tracheostomy; Humans; Female; Adolescent; Middle Aged; Respiration, Artificial; Infant; Cross Infection; Adult; Pneumonia; Male; Child, Preschool; Aged