Summary of findings for the main comparison. Semi‐recumbent position (30º to 60º) versus supine position (0° to 10°) for the prevention of ventilator‐associated pneumonia in adults requiring mechanical ventilation.
| Patient or population: adults requiring mechanical ventilation Settings: intensive care unit (ICU) Intervention: semi‐recumbent position (30º to 60º) Comparison: supine position (0° to 10°) | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| 0° to 10° supine position | Semi‐recumbentposition | ||||
| Clinically suspected VAP Follow‐up: > 48 hours | 402 per 1000 | 145 per 1000 (100 to 201) | RR 0.36 (0.25 to 0.50) | 759 (8 studies) | ⊕⊕⊕⊝
moderate due to risk of bias1 |
| Microbiologically confirmed VAP Follow‐up: > 48 hours | 316 per 1000 | 139 per 1000 (35 to 559) | RR 0.44 (0.11 to 1.77) | 419 (3 studies) | ⊕⊝⊝⊝
very low due to inconsistency2, imprecision3 and reporting bias4 |
| ICU mortality Follow‐up: > 48 hours | 276 per 1000 | 240 per 1000 (163 to 350) | RR 0.87 (0.59 to 1.27) | 307 (2 studies) | ⊕⊕⊝⊝
low due to imprecision3 and reporting bias4 |
| Hospital mortality Follow‐up: > 48 hours | 343 per 1000 | 288 per 1000 (202 to 411) | RR 0.84 (0.59 to 1.20) | 346 (3 studies) | ⊕⊕⊝⊝
low due to imprecision3 and reporting bias4 |
| Length of ICU stay Follow‐up: > 48 hours | — | The mean length of ICU stay in the intervention groups was 1.64 days lower (4.41 days lower to 1.14 days higher) | MD ‐1.64 days (‐4.41 to 1.14 days) | 346 (3 studies) | ⊕⊕⊕⊝
moderate due to imprecision3 |
| Length of hospital stay Follow‐up: > 48 hours | — | The mean length of hospital stay in the intervention groups was 9.47 days lower (34.21 days lower to 15.27 days higher) | MD ‐9.47 days (‐34.21 to 15.27 days) | 260 (2 studies) | ⊕⊝⊝⊝
very low due to inconsistency5, imprecision3 and reporting bias4 |
| Pressure ulcers Follow‐up: > 48 hours | 303 per 1000 | 276 per 1000 (182 to 418) |
RR 0.91 (0.60 to 1.38) |
221 (1 study) | ⊕⊕⊝⊝
low due to imprecision3 and reporting bias4 |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; ICU: intensive care unit; MD: mean difference; RR: risk ratio; VAP: ventilator‐associated pneumonia | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1Six out of eight studies did not report the methods of random sequence generation and allocation concealment. None of them were able to blind the patients and caregivers. Seven of eight did not blind outcome assessors. One of the studies was stopped early for benefit. 2Heterogeneity test P value = 0.006, I2 statistic = 87%. 395% confidence interval includes no effect and fails to exclude important benefit or important harm. 4Only a few studies reported this outcome and there was asymmetry in the funnel plot. 5Heterogeneity test P value < 0.00001, I2 statistic = 98%.