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

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene 2012-02, Vol.106 (2), p.90-97
• Main Authors: Loan, Huynh Thi, Parry, Janet, Nga, Nguyen Thi Ngoc, Yen, Lam Minh, Binh, Nguyen Thien, Thuy, Tran Thi Diem, Duong, Nguyen Minh, Campbell, James I., Thwaites, Louise, Farrar, Jeremy J., Parry, Christopher M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Body position; Child; Child, Preschool; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - prevention & control; Female; General aspects; Healthcare-associated pneumonia; Human bacterial diseases; Humans; Incidence; Infant; Infectious diseases; Intensive Care Units; Male; Medical sciences; Middle Aged; Patient Positioning; Pneumology; Pneumonia - epidemiology; Pneumonia - etiology; Pneumonia - microbiology; Pneumonia - prevention & control; Respiration, Artificial; Respiratory system : syndromes and miscellaneous diseases; Semi-recumbent; Tetanus; Tetanus - complications; Tracheostomy; Treatment Failure; Vietnam; Vietnam - epidemiology; Young Adult
• ISSN: 0035-9203; 1878-3503; 1878-3503
• DOI: 10.1016/j.trstmh.2011.10.010

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 > 48 h 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. [Clinical Trials.gov Identifier: NCT01331252]