Abstract
Seminal studies have demonstrated that tracheally intubated, mechanically ventilated
patients, positioned in supine horizontal position, are at a high risk of developing
ventilator-associated pneumonia, through aspiration of gastric pathogens. In the 1990s,
innovative clinical findings promoted a radical change in practice, through the use
of the semirecumbent position in all mechanically ventilated patients. Here, we critically
review the main indications, pulmonary effects, and controversies on the use of the
semirecumbent position. Also, we will depict potential roles of prone and lateral
positions in the prevention of ventilator-associated pneumonia. Our review will span
from preclinical experimental insights to clinical evidence, and we will discuss potential
controversies on the use of the semirecumbent position as the standard of care. We
will also detail potential alternatives to ultimately improve outcomes of tracheally
intubated and mechanically ventilated patients.
Keywords
ventilator-associated pneumonia - semirecumbent position - prone position - continuous
lateral position - tracheal intubation - critical care
