Ochotorena, Dorothy R.

BSN504/ Group#15

1. Clinical question: : In patients who are intubated and mechanically ventilated, is a
semirecumbent body position more effective than a supine body position for reducing the
incidence of nosocomial pneumonia?
2. Citation: A semirecumbent body position led to a lower rate of nosocomial pneumonia than
a supine position in mechanically ventilated adults
Information taken from:
http://ebn.bmj.com/content/3/3/84.full.pdf+html
Authors: Drakulovic MB, Torres A, Bauer TT, et al.Supine body position as a risk factor for
nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999
Nov 27;354:18518
Study characteristics
A. Patients included:
90 patients (mean age 65 y, 76% men) in the ICU who
been intubated and mechanically ventilated
B. Interventions compared:
To compare the semirecumbent body position is more effective than a supine body
position for reducing nosocomial pneumonia.
C. Outcome monitored:
Clinically suspected nosocomial pneumonia. Secondary outcome was
microbiological nosocomial pneumonia confirmed by bronchoalveolar lavage or
protected specimen brush cultures.
D. Does the study focus on a significant problem in clinical practice?
Yes, they are focused what position in a patient with mechanically ventilated adults.
3. Methodology
A.Methodology used:
Randomized (allocation concealed), unblinded, controlled trial.
B.Design:
Randomized (allocation concealed), unblinded, controlled trial with follow up for 72 hours
after extubation.
C.Setting:
2 intensive care units (ICUs) of a 1000 bed, tertiary care,
university hospital in Spain

D.Data sources:
Data gathered were from the results of the experiment of this study.
E.Subject selection:
a.)inclusion criteria:
43 patients were allocated to a semirecumbent body position (45 from the horizontal) and
47 to a supine body position, diagnosed with nosocomial pneumonia, 65 and above, male or
female and with mechanical ventilator.
b.)exclusion criteria:
Exclusion criteria if the patient is not in mechanical ventilator. And below 65 of age.

F.Has the original study been replicated?
No.

G.What were the risk and benefits of the nursing action/intervention tested in the
study?

Risk:
The participants will acquire further complications.

BENEFITS:
We will be able to know what position is effective on patient with on going
mechanical ventilator.


4. RESULT OF THE STUDY:
The study was stopped early when analysis showed that the semirecumbent position was
superior for reductions in clinically suspected pneumonia. Fewer patients in the
semirecumbent group developed clinically suspected (p=0.003) or microbiologically
confirmed (p=0.018) nosocomial pneumonia than in the supine group (table). Multivariate
analysis showed that microbiologically confirmed pneumonia was associated with enteral
nutrition (adjusted odds ratio [OR] 11.8, 95% CI 1.4 to 98) and supine body position (OR
6.1, CI 1.2 to 31). The groups did not differ for mortality (18% in the semirecumbent group
v 28% in the supine group, p=0.3).
5. Authors conclusion/recommendations:
For patients in the intensive care unit who were mechanically ventilated, a semirecumbent
body position was associated with a lower rate of nosocomial pneumonia than a supine
position.
6. Reviewers conclusion/commentary:
This article was effective strategy to reduce the risk of nosocomial pneumonia in patients
who are mechanically ventilated, especially when patients are receiving continuous enteral
feeding through a nasogastric tube
Evaluating nursing care practices
1. Safety:
This study was safely and no harm done.
2. Competence of the care provider:
This study seeks competence of the care provider because it takes practice before a care
provider can do this procedure properly.
3. Acceptability:
This procedure is acceptable because there isnt a need for a lot of resource to perform this
procedure.
4. Effectiveness:
The study shows what is the effective position.

5. Appropriateness:
This is appropriate to the readers who doesnt have any idea about the positioning the
patient with mechanical ventilator.
6. Efficiency:
The study is efficient because it gives enough knowledge about the positiong the patient.
7. Accesability:
The study is recommended that ICU patients be nursed in a semirecumbent position to
minimise the likelihood of nosocomial infections.