Posición semisentada permanente en UCI: ¿el inclinómetro como herramienta efectiva para la prevención de NAV? Experiencia en una unidad de Cuidados Intensivos de Bogotá

Abstract

IntroductionVentilator-associated pneumonia (VAP) is a common complication in intensive care units (ICUs), increasing the risk of mortality. The pathophysiology of VAP involves colonization of the orotracheal tube and microaspiration from the digestive tract, which is why various prevention strategies such as the permanent semi-Fowler position (30° to 45°) focus on reducing this phenomenon. ObjectiveTo describe the experience of implementing an inclinometer at the head of beds in the ICU and its impact on the frequency of VAP and tracheobronchitis. MethodologyDescriptive study using a case series of 24 patients in the ICU with the use of an external inclinometer. Adults with mechanical ventilation were included, excluding those with contraindications to head elevation. The frecuency of VAP and tracheobronchitis was determined. ResultsThe device was implemented in 3 beds of the ICU, collecting 24 patients, the median age of 58 years (IQR: 36.5-70). The median tilt with the device was 35°, and the time with tilt greater than 30° was 87.5% per day. The incidence of VAP and tracheobronchitis in one year was 8.33% (95% CI: 1.02%-26.99%) and 12.5% (95% CI: 2.65%-32.36%). ConclusionsThe use of the inclinometer offered a novel and safe way to monitor the semi-seated position of at least 30° in this series of patients and could potentially prevent ventilator-associated infections, although further research is needed to allow the generalization of the results.