The effect of prone position on the development of ventilator- associated pneumonia in COVID-19 patients in intensive care unit: a cross-sectional and case-control study

Abstract

Objective: To determine the effect of position on the devel- opment of ventilator-associated pneumonia (VAP) in coronavirus disease- 2019 (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 develop- ment. Results: In the regression analysis, the affecting variables the VAP in- cidence among all COVID-19 patients were prone position, hypertension (HT) disease, and other comorbid diseases (p<0.05). Further logistic re- gression 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 Acineto- bacter 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 infec- tion, especially during the first days of intubation.