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Literature Summary

Major Literature

1. Drakulovic. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999;354(9193):1851–1858 
  • In a single centre, randomized controlled trial comparing semirecumbent with supine body position in 86 mechanically ventilated medical patients, the semirecumbent group had a lower frequency of suspected noscomial pneumonia (8% vs 34%; 95% CI for difference 10·0 to 42.0; P=0·003) and microbiologically confirmed pneumonia (5% vs 23%; 95% CI 4.2 to 31.8; p=0·018). Supine body position (odds ratio 6.8; 95% CI 1.7 – 26.7; P=0·006) and enteral nutrition (odds ration 5.7; 95% CI 1.5 – 22.8; P=0·013) were independent risk factors for nosocomial pneumonia. 
  • The addition of nighttime intensivist staffing to a low-intensity daytime staffing model was associated with reduced mortality. However, a reduction in mortality was not seen in ICUs with high-intensity daytime staffing.
  • The use of gloves and gowns for all patient contact compared with usual care among patients in medical and surgical ICUs did not result in a difference in the primary outcome of acquisition of MRSA or VRE. Although there was a lower risk of MRSA acquisition alone and no difference in adverse events, these secondary outcomes require replication before reaching definitive conclusions.