Gravity VAP
Research type
Research Study
Full title
Prospective, Randomized, Multi-Center Trial of Lateral Trendelenburg Versus Semi-Recumbent Body Position In Mechanically Ventilated Patients For The Prevention of Ventilator Associated Pneumonia.
IRAS ID
163100
Contact name
Matt Wise
Contact email
Sponsor organisation
Policlinico Hospital
Clinicaltrials.gov Identifier
Duration of Study in the UK
3 years, 0 months, 4 days
Research summary
Ventilator associated pneumonia (VAP) is the most prevalent infection in patients who are critically ill and mechanically ventilated (artificial breathing machine), and is associated with prolonged critical care and hospital stay, an increase in healthcare costs and mortality (death).
It is widely accepted that the stomach of mechanically ventilated patients is often colonized with bacteria. The use of antacid medications and artificial feeding via a tube compromises the acidity normally present in the stomach which facilitates the growth of bacteria.
Reflux from the stomach is another common problem in mechanically ventilated artificially fed patients. It is thought to contribute to VAP by enabling bacteria from the stomach to enter and colonize the oral cavity, before being aspirated into the lungs past the endotracheal (breathing) tube.
Previous studies suggest that nursing mechanically (artificially) ventilated patients in a semi-recumbent position (sitting up position) reduces the aspiration of gastric and oral contents contaminated with bacteria. However reflux was not prevented by this position and therefore bacteria may still be aspirated from into the lungs.
The recovery position is a lateral position widely used to prevent aspiration in the unconscious patient as it facilitates natural drainage of oropharyngeal (oral cavity) secretions and gastric reflux contents out through the mouth. Animal experiments have shown that a position that places the level of the trachea (main airway tube)lower than horizontal (lateral Trendelenburg position) can prevent any aspiration of oropharyngeal secretions across the endotracheal tube and cuff, facilitating drainage of the secretions away from the airways and lungs entirely.
The purpose of this study is to compare the efficacy and safety of the two body positions (Semi-Recumbent versus lateral Trendelenburg) in reducing the incidence of VAP in critically ill, mechanically ventilated sedated patients.REC name
Wales REC 3
REC reference
14/WA/1244
Date of REC Opinion
20 Jan 2015
REC opinion
Further Information Favourable Opinion