.: ORİJİNAL ARAŞTIRMA
The Effect of Prone Position on the Development of VentilatorAssociated Pneumonia in COVID-19 Patients in Intensive Care Unit: A Cross-Sectional and Case-Control Study
Yoğun Bakım Ünitesindeki COVID-19 Hastalarında Yüzüstü Pozisyonun Ventilatörle İlişkili Pnömoni Gelişimine Etkisi: Kesitsel ve Vaka Kontrol Çalışma
Turkiye Klinikleri J Med Sci. 2025;45(2):92-100
doi: 10.5336/medsci.2024-103334
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: To determine the effect of position on the development of ventilator-associated pneumonia (VAP) in coronavirus disease2019 (COVID-19) patients in intensive care unit. Material and Methods: This cross-sectional, retrospective, and case-control study included 138 COVID-19 patients intubated in the medical-surgical intensive care unit of Koç University Hospital in March 2020-2021. Multiple logistic regression analyses were conducted to determine the factors affecting VAP development. Results: In the regression analysis, the affecting variables the VAP incidence among all COVID-19 patients were prone position, hypertension (HT) disease, and other comorbid diseases (p<0.05). Further logistic regression analysis among prone-positioned COVID-19 patients showed that the duration of intubation odds ratio (OR) 1.14, 95% Confidence Interval (CI) 1.04-1.25), smoking (OR 8.14, 95% CI 1.29-51.16), and having other comorbid diseases (OR 0.15, 95% CI 0.03-0.70) increased the risk of VAP development. It was also found that the incidence of VAP decreased as the prone time increased (OR) 0.68, 95% CI 0.52-0.89) (p<0.05). Conclusion: The risk for VAP development increases in prone positioned patients with HT and other comorbid diseases and VAP develops often due to Acinetobacter baumannii. In prone position, the risk of VAP increased in patients with prolonged intubation time, smokers, and other comorbid diseases, and decreased as the prone time was prolonged. It is important to maintain care approaches included in VAP bundles, such as oral care of patients in prone positions to reduce the incidence of VAP secondary to COVID-19 infection, especially during the first days of intubation.
Keywords: Prone; supine; ventilator-associated pneumonia; acute respiratory distress syndrome; COVID-19
Objective: To determine the effect of position on the development of ventilator-associated pneumonia (VAP) in coronavirus disease2019 (COVID-19) patients in intensive care unit. Material and Methods: This cross-sectional, retrospective, and case-control study included 138 COVID-19 patients intubated in the medical-surgical intensive care unit of Koç University Hospital in March 2020-2021. Multiple logistic regression analyses were conducted to determine the factors affecting VAP development. Results: In the regression analysis, the affecting variables the VAP incidence among all COVID-19 patients were prone position, hypertension (HT) disease, and other comorbid diseases (p<0.05). Further logistic regression analysis among prone-positioned COVID-19 patients showed that the duration of intubation odds ratio (OR) 1.14, 95% Confidence Interval (CI) 1.04-1.25), smoking (OR 8.14, 95% CI 1.29-51.16), and having other comorbid diseases (OR 0.15, 95% CI 0.03-0.70) increased the risk of VAP development. It was also found that the incidence of VAP decreased as the prone time increased (OR) 0.68, 95% CI 0.52-0.89) (p<0.05). Conclusion: The risk for VAP development increases in prone positioned patients with HT and other comorbid diseases and VAP develops often due to Acinetobacter baumannii. In prone position, the risk of VAP increased in patients with prolonged intubation time, smokers, and other comorbid diseases, and decreased as the prone time was prolonged. It is important to maintain care approaches included in VAP bundles, such as oral care of patients in prone positions to reduce the incidence of VAP secondary to COVID-19 infection, especially during the first days of intubation.
Keywords: Prone; supine; ventilator-associated pneumonia; acute respiratory distress syndrome; COVID-19
ÖZET
Amaç: Bu çalışmanın amacı, yoğun bakım ünitesinde yatan koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] hastalarında pozisyonun ventilatör ilişkili pnömoni (VİP) gelişimine etkisini belirlemektir. Gereç ve Yöntemler: Bu kesitsel, retrospektif ve vaka kontrol çalışmasına Mart 2020-2021'de Koç Üniversitesi Hastanesi yoğun bakım ünitesinde entübe edilen 138 COVID-19 hastasını dâhil edildi. VİP gelişimini etkileyen faktörlerin belirlenmesi amacıyla çoklu lojistik regresyon analizleri yapıldı. Bulgular: Regresyon analizinde tüm COVID-19 hastalarında VİP görülme sıklığını etkileyen değişkenlerin pron pozisyonu, hipertansiyon (HT) varlığı ve komorbid hastalıklar olduğu bulundu (p<0,05). Ayrıca, pron pozisyondaki hastalar arasında ileri lojistik regresyon analizi, entübasyon süresinin odds oranı (OR 1,14, %95 CI 1,04-1,25), sigara içmenin (OR 8,14, %95 CI 1,29-51,16) ve diğer eşlik eden hastalıklara sahip olmanın (OR 0,15, %95 CI 0,03-0,70) VİP gelişme riskini artırdığı bulundu. Son olarak, pron süresi arttıkça VİP sıklığının azaldığı belirlendi (OR 0,68, %95 CI 0,52-0,89) (p<0,05). Sonuç: Yüzüstü pozisyonda HT ve eşlik eden diğer hastalıkları olan hastalarda VİP gelişme riski artmakta ve VİP sıklıkla Acinetobacter baumannii'ye bağlı olarak gelişmektedir. Yüzüstü pozisyonda, entübasyon süresi uzamış, sigara içen ve komorbid hastalıkları olan hastalarda VİP riski artmakta, pron süresi uzadıkça azalmaktadır. Özellikle entübasyonun ilk günlerinde, COVID-19 enfeksiyonuna sekonder VİP görülme sıklığını azaltmak için pron pozisyonundaki hastaların ağız bakımı gibi VİP önlemlerinde yer alan bakım yaklaşımların sürdürülmesi önemlidir.
Anahtar Kelimeler: Pron; supin; ventilatörle ilişkili pnömoni; akut solunumsal stres sendromu; COVID-19
Amaç: Bu çalışmanın amacı, yoğun bakım ünitesinde yatan koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] hastalarında pozisyonun ventilatör ilişkili pnömoni (VİP) gelişimine etkisini belirlemektir. Gereç ve Yöntemler: Bu kesitsel, retrospektif ve vaka kontrol çalışmasına Mart 2020-2021'de Koç Üniversitesi Hastanesi yoğun bakım ünitesinde entübe edilen 138 COVID-19 hastasını dâhil edildi. VİP gelişimini etkileyen faktörlerin belirlenmesi amacıyla çoklu lojistik regresyon analizleri yapıldı. Bulgular: Regresyon analizinde tüm COVID-19 hastalarında VİP görülme sıklığını etkileyen değişkenlerin pron pozisyonu, hipertansiyon (HT) varlığı ve komorbid hastalıklar olduğu bulundu (p<0,05). Ayrıca, pron pozisyondaki hastalar arasında ileri lojistik regresyon analizi, entübasyon süresinin odds oranı (OR 1,14, %95 CI 1,04-1,25), sigara içmenin (OR 8,14, %95 CI 1,29-51,16) ve diğer eşlik eden hastalıklara sahip olmanın (OR 0,15, %95 CI 0,03-0,70) VİP gelişme riskini artırdığı bulundu. Son olarak, pron süresi arttıkça VİP sıklığının azaldığı belirlendi (OR 0,68, %95 CI 0,52-0,89) (p<0,05). Sonuç: Yüzüstü pozisyonda HT ve eşlik eden diğer hastalıkları olan hastalarda VİP gelişme riski artmakta ve VİP sıklıkla Acinetobacter baumannii'ye bağlı olarak gelişmektedir. Yüzüstü pozisyonda, entübasyon süresi uzamış, sigara içen ve komorbid hastalıkları olan hastalarda VİP riski artmakta, pron süresi uzadıkça azalmaktadır. Özellikle entübasyonun ilk günlerinde, COVID-19 enfeksiyonuna sekonder VİP görülme sıklığını azaltmak için pron pozisyonundaki hastaların ağız bakımı gibi VİP önlemlerinde yer alan bakım yaklaşımların sürdürülmesi önemlidir.
Anahtar Kelimeler: Pron; supin; ventilatörle ilişkili pnömoni; akut solunumsal stres sendromu; COVID-19
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