CI: Monitoring Criteria: Patient Positioning (2006)

Citation:
Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: An evidence-based systematic review. Ann Int Med 2003; 138(6): 494-501. PubMed ID: 12639084
 
Study Design:
Meta-analysis or Systematic Review
Class:
M - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

To perform a literature review and synthesis of methods for prevention of ventilator-associated pneumonia

Inclusion Criteria:

Only studies of level 3 or greater quality

Exclusion Criteria:

 

Description of Study Protocol:
  • MEDLINE, Cocharane Library and bibliographies of retrieved articles
  • PCT with clinically important or surrogate outcomes with link to clinically important outcomes
  • Review of literature
  • Grading was I if evidence from meta-analysis or systematic review of RCT, II if RCT with clinically important outcome, III if nonrandomized CT; and IV if controlled observation study.
Data Collection Summary:
  • Ventilator-associated pneumonia
  • Gastroesophageal reflux
  • Aspiration events
Description of Actual Data Sample:
  • 433 articles reiewed
  • 66 kept
Summary of Results:
  • Supine positioning is independently associated with ventilator-associated pneumonia (VAP) development
  • From 3 trials, gastroesophageal reflux and aspiration events (surrogate endpoints) and VAP are  decreased  by 45-degree head of bed elevation
  • Sucralfate rather than H2-antagonists for stress ulcer prophylaxis
  • Selective digestive tract decontamination
  • Aspiration of subglottic secretions and oscillating beds may be useful in select populations
  • No evidence to support specific methods of feeding (small bowel, metoclopramide) or frequency of vent circuit changes on VAP outcomes
Author Conclusion:

Promising treatment modalities for nosocomial VAP prevention include use of a semi-recumbent position for all eligible patients (Grade IIA), sucralfate rather than H2 blockers (Grade I),  aspiration of subglottic secretions (Grade IIA) and oscillating beds in surgical or neurologic patients (Grade I).

Funding Source:
Government: US Dept. of Veterans Affairs, NIH
Reviewer Comments:

4 references for semi-recumbent positioning.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes