Semi-recumbent body position fails to prevent healthcare-associated pneumonia in Vietnamese patients with severe tetanus.
Bottom Line: 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.
Affiliation: Hospital for Tropical Diseases, 190 Ben Ham Tu, District 5, Ho Chi Minh City, Vietnam.Show MeSH
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Mentions: There were 419 admissions (excluding neonates) to the tetanus ward between August 2000 and March 2002. Six patients were immediately excluded as they did not have tetanus, 88 were not severe enough to require admission to the ICU and 93 had been in a previous hospital for >24 h. A total of 232 patients were entered into the study and randomised (Figure 1): 115 patients were randomised to be nursed in a supine position and 117 to be nursed in a semi-recumbent position. Three supine patients were subsequently considered not to have tetanus and excluded. The only important difference in the characteristics of the two groups of patients, at the time of admission, was that a significantly higher proportion of semi-recumbent patients had previously received an antimicrobial (Table 1). There was no significant difference in the TSS between the two groups.
Affiliation: Hospital for Tropical Diseases, 190 Ben Ham Tu, District 5, Ho Chi Minh City, Vietnam.