Prone Ventilation To Prevent Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) refers to pneumonia that arises more than 48 h after endotracheal intubation. VAP is the most common hospitalacquired infection among patients requiring mechanical ventilation and is associated with high morbidity, mortality and health-care costs [1,2], emphasising the need of risk-reduction strategies. Some strategies are strongly recommended by recent guidelines: general infection control measures, use of non-invasive ventilation whenever possible, semirecumbent position and continuous aspiration of subglottic secretions [1]. Prone positioning has repeatedly been shown to improve arterial oxygenation in patients with hypoxaemic respiratory failure who receive mechanical ventilation. Unfortunately, three randomised studies failed to show an improvement in survival [3, 4, 5]. However, prone positioning might interfere with the mechanisms involved in the pathogenesis of VAP.