<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02984657</url>
  </required_header>
  <id_info>
    <org_study_id>15-023</org_study_id>
    <nct_id>NCT02984657</nct_id>
  </id_info>
  <brief_title>Reverse Trendelenburg Positioning and Its Effect on Outcomes: a Retrospective Study of Consecutive Patients</brief_title>
  <official_title>Evaluation of Operating Room Reverse Trendelenburg Positioning and Its Effect on Postoperative Hypoxemia, Aspiration, and Length of Stay: a Retrospective Study of Consecutive Patients</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>C. Michael Dunham</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>St. Elizabeth Youngstown Hospital</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Mercy Health Ohio</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      The purpose of this study is to investigate whether intraoperative reverse Trendelenburg&#xD;
      positioning decreases postoperative hypoxemia and perioperative pulmonary aspiration rates.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Intraoperative pulmonary aspiration can cause death and lead to morbidity. In addition,&#xD;
      reliable estimates of aspiration rates are uncertain. In part, this ambiguity relates to the&#xD;
      lack of prospective data. Relevant studies are retrospective chart reviews or results from&#xD;
      voluntary reporting databases. Furthermore, aspiration diagnosis can be imprecise. The&#xD;
      finding is certain when there is aspiration of bile or particulate matter from the&#xD;
      tracheobronchial tree or there is endoscopic visualization. However, the diagnosis is&#xD;
      presumptive when there is intraoperative or postoperative development of a new chest x-ray&#xD;
      infiltrate and attendant tachypnea, hypoxia, wheezing, or changes in ventilator airway&#xD;
      pressures.&#xD;
&#xD;
      Most patients undergoing general endotracheal anesthesia are in the supine or horizontal&#xD;
      position. However, evidence from the literature demonstrates that the supine position in&#xD;
      mechanically ventilated patients is a risk for aspiration and ventilator associated pneumonia&#xD;
      (VAP). During intensive care unit (ICU) mechanical ventilation, the Institute for Healthcare&#xD;
      Improvement recommends elevating the head of the bed to prevent pulmonary aspiration and VAP.&#xD;
      Other investigations have shown a profound relationship between horizontal positioning and&#xD;
      intra-operative aspiration. There is substantial operating room, ICU, and animal&#xD;
      investigative evidence that aspiration occurs despite the presence of a cuffed endotracheal&#xD;
      tube. Likewise, previous work by this group showed a 30% perioperative hypoxemia rate, which&#xD;
      was significantly associated with horizontal positioning. The post-operative length of&#xD;
      hospital stay was 2 days longer with hypoxemia, compared to no hypoxemia (p &lt;0.0001) and this&#xD;
      represented a total of 300 additional days for the 2 months of the study.&#xD;
&#xD;
      The purpose of this retrospective study is to repeat the investigation after adopting a&#xD;
      recent policy change of 10-degree Reverse Trendelenburg position as the routine for surgical&#xD;
      patients, unless deemed inappropriate by either the anesthesiology or operating room nursing&#xD;
      staff.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date>May 2015</start_date>
  <completion_date type="Actual">September 2015</completion_date>
  <primary_completion_date type="Actual">September 2015</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Cohort</observational_model>
    <time_perspective>Retrospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Postoperative hypoxemia</measure>
    <time_frame>48 hours postoperatively</time_frame>
  </primary_outcome>
  <secondary_outcome>
    <measure>Perioperative pulmonary aspiration</measure>
    <time_frame>48 hours postoperatively</time_frame>
  </secondary_outcome>
  <number_of_groups>2</number_of_groups>
  <enrollment type="Actual">1500</enrollment>
  <condition>Aspiration, Respiratory</condition>
  <condition>Hypoxia</condition>
  <condition>Perioperative Period</condition>
  <condition>Supine Position</condition>
  <arm_group>
    <arm_group_label>2012 patients</arm_group_label>
    <description>Surgical patients in 2012 with anesthesia and nursing staff less attuned to intraoperative RTP.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>2015 patients</arm_group_label>
    <description>Surgical patients in 2015 with enhanced anesthesia and nursing staff awareness and use of intraoperative RTP.</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Surgical patients in 2012 with anesthesia and nursing staff less attuned to intraoperative RTP.</intervention_name>
    <description>RTP, reverse Trendelenburg positioning</description>
    <arm_group_label>2012 patients</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Surgical patients in 2015 with enhanced anesthesia and nursing staff awareness and use of intraoperative RTP.</intervention_name>
    <description>RTP, reverse Trendelenburg positioning</description>
    <arm_group_label>2015 patients</arm_group_label>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Surgical patients from an urban hospital&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Patients undergoing endotracheal intubation and general anesthesia&#xD;
&#xD;
          -  Age ≥18 years&#xD;
&#xD;
          -  Glasgow Coma Scale score ≥13 (prior to tracheal intubation)&#xD;
&#xD;
          -  American Society of Anesthesiologists classification I-IV&#xD;
&#xD;
          -  Pre-operative pulmonary stability&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Tracheal intubation prior to emergency department arrival&#xD;
&#xD;
          -  Cardiac and thoracic surgical patients&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>C. Michael Dunham, MD</last_name>
    <role>Principal Investigator</role>
    <affiliation>St. Elizabeth Youngstown Hospital</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>St. Elizabeth Youngstown Hospital</name>
      <address>
        <city>Youngstown</city>
        <state>Ohio</state>
        <zip>44501</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Dunham CM, Hileman BM, Hutchinson AE, Chance EA, Huang GS. Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients. BMC Anesthesiol. 2014 Jun 9;14:43. doi: 10.1186/1471-2253-14-43. eCollection 2014.</citation>
    <PMID>24940115</PMID>
  </reference>
  <reference>
    <citation>Cotton BR, Smith G. The lower oesophageal sphincter and anaesthesia. Br J Anaesth. 1984 Jan;56(1):37-46. doi: 10.1093/bja/56.1.37. No abstract available.</citation>
    <PMID>6140931</PMID>
  </reference>
  <reference>
    <citation>Tiret L, Desmonts JM, Hatton F, Vourc'h G. Complications associated with anaesthesia--a prospective survey in France. Can Anaesth Soc J. 1986 May;33(3 Pt 1):336-44. doi: 10.1007/BF03010747.</citation>
    <PMID>3719435</PMID>
  </reference>
  <reference>
    <citation>Kozlow JH, Berenholtz SM, Garrett E, Dorman T, Pronovost PJ. Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000. Crit Care Med. 2003 Jul;31(7):1930-7. doi: 10.1097/01.CCM.0000069738.73602.5F.</citation>
    <PMID>12847385</PMID>
  </reference>
  <reference>
    <citation>Kluger MT, Short TG. Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia. 1999 Jan;54(1):19-26. doi: 10.1046/j.1365-2044.1999.00642.x.</citation>
    <PMID>10209365</PMID>
  </reference>
  <reference>
    <citation>Ewig S, Torres A. Prevention and management of ventilator-associated pneumonia. Curr Opin Crit Care. 2002 Feb;8(1):58-69. doi: 10.1097/00075198-200202000-00010.</citation>
    <PMID>12205408</PMID>
  </reference>
  <reference>
    <citation>Torres A, Serra-Batlles J, Ros E, Piera C, Puig de la Bellacasa J, Cobos A, Lomena F, Rodriguez-Roisin R. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992 Apr 1;116(7):540-3. doi: 10.7326/0003-4819-116-7-540.</citation>
    <PMID>1543307</PMID>
  </reference>
  <reference>
    <citation>Reali-Forster C, Kolobow T, Giacomini M, Hayashi T, Horiba K, Ferrans VJ. New ultrathin-walled endotracheal tube with a novel laryngeal seal design. Long-term evaluation in sheep. Anesthesiology. 1996 Jan;84(1):162-72; discussion 27A. doi: 10.1097/00000542-199601000-00019.</citation>
    <PMID>8572330</PMID>
  </reference>
  <reference>
    <citation>Petring OU, Adelhoj B, Jensen BN, Pedersen NO, Lomholt N. Prevention of silent aspiration due to leaks around cuffs of endotracheal tubes. Anesth Analg. 1986 Jul;65(7):777-80.</citation>
    <PMID>3717617</PMID>
  </reference>
  <reference>
    <citation>Seegobin RD, van Hasselt GL. Aspiration beyond endotracheal cuffs. Can Anaesth Soc J. 1986 May;33(3 Pt 1):273-9. doi: 10.1007/BF03010737.</citation>
    <PMID>3719428</PMID>
  </reference>
  <reference>
    <citation>Smith G, Ng A. Gastric reflux and pulmonary aspiration in anaesthesia. Minerva Anestesiol. 2003 May;69(5):402-6.</citation>
    <PMID>12768174</PMID>
  </reference>
  <reference>
    <citation>Ferrer R, Artigas A. Clinical review: non-antibiotic strategies for preventing ventilator-associated pneumonia. Crit Care. 2002 Feb;6(1):45-51. doi: 10.1186/cc1452. Epub 2001 Jan 11.</citation>
    <PMID>11940265</PMID>
  </reference>
  <reference>
    <citation>Keenan SP, Heyland DK, Jacka MJ, Cook D, Dodek P. Ventilator-associated pneumonia. Prevention, diagnosis, and therapy. Crit Care Clin. 2002 Jan;18(1):107-25. doi: 10.1016/s0749-0704(03)00068-x.</citation>
    <PMID>11910725</PMID>
  </reference>
  <reference>
    <citation>Koeman M, van der Ven AJ, Ramsay G, Hoepelman IM, Bonten MJ. Ventilator-associated pneumonia: recent issues on pathogenesis, prevention and diagnosis. J Hosp Infect. 2001 Nov;49(3):155-62. doi: 10.1053/jhin.2001.1073. No abstract available.</citation>
    <PMID>11716631</PMID>
  </reference>
  <reference>
    <citation>Fernandez-Crehuet R, Diaz-Molina C, de Irala J, Martinez-Concha D, Salcedo-Leal I, Masa-Calles J. Nosocomial infection in an intensive-care unit: identification of risk factors. Infect Control Hosp Epidemiol. 1997 Dec;18(12):825-30.</citation>
    <PMID>9442407</PMID>
  </reference>
  <reference>
    <citation>Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999 Nov 27;354(9193):1851-8. doi: 10.1016/S0140-6736(98)12251-1.</citation>
    <PMID>10584721</PMID>
  </reference>
  <reference>
    <citation>Kollef MH. Ventilator-associated pneumonia. A multivariate analysis. JAMA. 1993 Oct 27;270(16):1965-70.</citation>
    <PMID>8411554</PMID>
  </reference>
  <reference>
    <citation>Institute for Healthcare Improvement: Prevent ventilator-associated pneumonia. Institute for Healthcare Improvement. 2012. http://www.ihi.org/knowledge/Pages/Changes/ImplementtheVentilatorBundle.aspx; Accessed 9 Dec 2013.</citation>
  </reference>
  <reference>
    <citation>Blitt CD, Gutman HL, Cohen DD, Weisman H, Dillon JB. &quot;Silent&quot; regurgitation and aspiration during general anesthesia. Anesth Analg. 1970 Sep-Oct;49(5):707-13. No abstract available.</citation>
    <PMID>5534428</PMID>
  </reference>
  <reference>
    <citation>McEwen DR. Intraoperative positioning of surgical patients. AORN J. 1996 Jun;63(6):1059-63, 1066-79; quiz 1080-6. doi: 10.1016/s0001-2092(06)63293-6.</citation>
    <PMID>8771317</PMID>
  </reference>
  <reference>
    <citation>Adedeji R, Oragui E, Khan W, Maruthainar N. The importance of correct patient positioning in theatres and implications of mal-positioning. J Perioper Pract. 2010 Apr;20(4):143-7. doi: 10.1177/175045891002000403.</citation>
    <PMID>20446625</PMID>
  </reference>
  <reference>
    <citation>Smith KA. Positioning principles. An anatomical review. AORN J. 1990 Dec;52(6):1196-202, 1204, 1206-8. doi: 10.1016/s0001-2092(07)69197-2. No abstract available.</citation>
    <PMID>2278485</PMID>
  </reference>
  <reference>
    <citation>Mulier JP, Dillemans B, Van Cauwenberge S. Impact of the patient's body position on the intraabdominal workspace during laparoscopic surgery. Surg Endosc. 2010 Jun;24(6):1398-402. doi: 10.1007/s00464-009-0785-8. Epub 2010 Jan 7.</citation>
    <PMID>20054583</PMID>
  </reference>
  <reference>
    <citation>Abdulla S. Pulmonary aspiration in perioperative medicine. Acta Anaesthesiol Belg. 2013;64(1):1-13.</citation>
    <PMID>23767172</PMID>
  </reference>
  <reference>
    <citation>Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth. 1999 Sep;83(3):453-60. doi: 10.1093/bja/83.3.453. No abstract available.</citation>
    <PMID>10655918</PMID>
  </reference>
  <reference>
    <citation>Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001 Aug;93(2):494-513. doi: 10.1097/00000539-200108000-00050.</citation>
    <PMID>11473886</PMID>
  </reference>
  <reference>
    <citation>Kalinowski CP, Kirsch JR. Strategies for prophylaxis and treatment for aspiration. Best Pract Res Clin Anaesthesiol. 2004 Dec;18(4):719-37. doi: 10.1016/j.bpa.2004.05.008.</citation>
    <PMID>15460555</PMID>
  </reference>
  <verification_date>December 2016</verification_date>
  <study_first_submitted>December 4, 2016</study_first_submitted>
  <study_first_submitted_qc>December 4, 2016</study_first_submitted_qc>
  <study_first_posted type="Estimate">December 7, 2016</study_first_posted>
  <last_update_submitted>December 4, 2016</last_update_submitted>
  <last_update_submitted_qc>December 4, 2016</last_update_submitted_qc>
  <last_update_posted type="Estimate">December 7, 2016</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor-Investigator</responsible_party_type>
    <investigator_affiliation>Mercy Health Ohio</investigator_affiliation>
    <investigator_full_name>C. Michael Dunham</investigator_full_name>
    <investigator_title>Research Associate, St. Elizabeth Youngstown Hospital</investigator_title>
  </responsible_party>
  <keyword>Hypoxemia</keyword>
  <keyword>Reverse Trendelenburg</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Respiratory Aspiration</mesh_term>
    <mesh_term>Hypoxia</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Anesthetics</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02984657
org study id: 15-023
nct id: NCT02984657
lead sponsor: 
collaborator: 
has dmc: No
The purpose of this study is to investigate whether intraoperative reverse Trendelenburg
      positioning decreases postoperative hypoxemia and perioperative pulmonary aspiration rates.
Intraoperative pulmonary aspiration can cause death and lead to morbidity. In addition,
      reliable estimates of aspiration rates are uncertain. In part, this ambiguity relates to the
      lack of prospective data. Relevant studies are retrospective chart reviews or results from
      voluntary reporting databases. Furthermore, aspiration diagnosis can be imprecise. The
      finding is certain when there is aspiration of bile or particulate matter from the
      tracheobronchial tree or there is endoscopic visualization. However, the diagnosis is
      presumptive when there is intraoperative or postoperative development of a new chest x-ray
      infiltrate and attendant tachypnea, hypoxia, wheezing, or changes in ventilator airway
      pressures.

      Most patients undergoing general endotracheal anesthesia are in the supine or horizontal
      position. However, evidence from the literature demonstrates that the supine position in
      mechanically ventilated patients is a risk for aspiration and ventilator associated pneumonia
      (VAP). During intensive care unit (ICU) mechanical ventilation, the Institute for Healthcare
      Improvement recommends elevating the head of the bed to prevent pulmonary aspiration and VAP.
      Other investigations have shown a profound relationship between horizontal positioning and
      intra-operative aspiration. There is substantial operating room, ICU, and animal
      investigative evidence that aspiration occurs despite the presence of a cuffed endotracheal
      tube. Likewise, previous work by this group showed a 30% perioperative hypoxemia rate, which
      was significantly associated with horizontal positioning. The post-operative length of
      hospital stay was 2 days longer with hypoxemia, compared to no hypoxemia (p <0.0001) and this
      represented a total of 300 additional days for the 2 months of the study.

      The purpose of this retrospective study is to repeat the investigation after adopting a
      recent policy change of 10-degree Reverse Trendelenburg position as the routine for surgical
      patients, unless deemed inappropriate by either the anesthesiology or operating room nursing
      staff.
observational model: Cohort
time perspective: Retrospective
measure: Postoperative hypoxemia
time frame: 48 hours postoperatively
measure: Perioperative pulmonary aspiration
time frame: 48 hours postoperatively
arm group label: 2012 patients
description: Surgical patients in 2012 with anesthesia and nursing staff less attuned to intraoperative RTP.
arm group label: 2015 patients
description: Surgical patients in 2015 with enhanced anesthesia and nursing staff awareness and use of intraoperative RTP.
intervention type: Procedure
intervention name: Surgical patients in 2012 with anesthesia and nursing staff less attuned to intraoperative RTP.
description: RTP, reverse Trendelenburg positioning
arm group label: 2012 patients
intervention type: Procedure
intervention name: Surgical patients in 2015 with enhanced anesthesia and nursing staff awareness and use of intraoperative RTP.
description: RTP, reverse Trendelenburg positioning
arm group label: 2015 patients
study pop: 
sampling method: Probability Sample
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: C. Michael Dunham, MD
role: Principal Investigator
affiliation: St. Elizabeth Youngstown Hospital
facility: 
country: United States
citation: Dunham CM, Hileman BM, Hutchinson AE, Chance EA, Huang GS. Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients. BMC Anesthesiol. 2014 Jun 9;14:43. doi: 10.1186/1471-2253-14-43. eCollection 2014.
PMID: 24940115
citation: Cotton BR, Smith G. The lower oesophageal sphincter and anaesthesia. Br J Anaesth. 1984 Jan;56(1):37-46. doi: 10.1093/bja/56.1.37. No abstract available.
PMID: 6140931
citation: Tiret L, Desmonts JM, Hatton F, Vourc'h G. Complications associated with anaesthesia--a prospective survey in France. Can Anaesth Soc J. 1986 May;33(3 Pt 1):336-44. doi: 10.1007/BF03010747.
PMID: 3719435
citation: Kozlow JH, Berenholtz SM, Garrett E, Dorman T, Pronovost PJ. Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000. Crit Care Med. 2003 Jul;31(7):1930-7. doi: 10.1097/01.CCM.0000069738.73602.5F.
PMID: 12847385
citation: Kluger MT, Short TG. Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS). Anaesthesia. 1999 Jan;54(1):19-26. doi: 10.1046/j.1365-2044.1999.00642.x.
PMID: 10209365
citation: Ewig S, Torres A. Prevention and management of ventilator-associated pneumonia. Curr Opin Crit Care. 2002 Feb;8(1):58-69. doi: 10.1097/00075198-200202000-00010.
PMID: 12205408
citation: Torres A, Serra-Batlles J, Ros E, Piera C, Puig de la Bellacasa J, Cobos A, Lomena F, Rodriguez-Roisin R. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992 Apr 1;116(7):540-3. doi: 10.7326/0003-4819-116-7-540.
PMID: 1543307
citation: Reali-Forster C, Kolobow T, Giacomini M, Hayashi T, Horiba K, Ferrans VJ. New ultrathin-walled endotracheal tube with a novel laryngeal seal design. Long-term evaluation in sheep. Anesthesiology. 1996 Jan;84(1):162-72; discussion 27A. doi: 10.1097/00000542-199601000-00019.
PMID: 8572330
citation: Petring OU, Adelhoj B, Jensen BN, Pedersen NO, Lomholt N. Prevention of silent aspiration due to leaks around cuffs of endotracheal tubes. Anesth Analg. 1986 Jul;65(7):777-80.
PMID: 3717617
citation: Seegobin RD, van Hasselt GL. Aspiration beyond endotracheal cuffs. Can Anaesth Soc J. 1986 May;33(3 Pt 1):273-9. doi: 10.1007/BF03010737.
PMID: 3719428
citation: Smith G, Ng A. Gastric reflux and pulmonary aspiration in anaesthesia. Minerva Anestesiol. 2003 May;69(5):402-6.
PMID: 12768174
citation: Ferrer R, Artigas A. Clinical review: non-antibiotic strategies for preventing ventilator-associated pneumonia. Crit Care. 2002 Feb;6(1):45-51. doi: 10.1186/cc1452. Epub 2001 Jan 11.
PMID: 11940265
citation: Keenan SP, Heyland DK, Jacka MJ, Cook D, Dodek P. Ventilator-associated pneumonia. Prevention, diagnosis, and therapy. Crit Care Clin. 2002 Jan;18(1):107-25. doi: 10.1016/s0749-0704(03)00068-x.
PMID: 11910725
citation: Koeman M, van der Ven AJ, Ramsay G, Hoepelman IM, Bonten MJ. Ventilator-associated pneumonia: recent issues on pathogenesis, prevention and diagnosis. J Hosp Infect. 2001 Nov;49(3):155-62. doi: 10.1053/jhin.2001.1073. No abstract available.
PMID: 11716631
citation: Fernandez-Crehuet R, Diaz-Molina C, de Irala J, Martinez-Concha D, Salcedo-Leal I, Masa-Calles J. Nosocomial infection in an intensive-care unit: identification of risk factors. Infect Control Hosp Epidemiol. 1997 Dec;18(12):825-30.
PMID: 9442407
citation: Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999 Nov 27;354(9193):1851-8. doi: 10.1016/S0140-6736(98)12251-1.
PMID: 10584721
citation: Kollef MH. Ventilator-associated pneumonia. A multivariate analysis. JAMA. 1993 Oct 27;270(16):1965-70.
PMID: 8411554
citation: Institute for Healthcare Improvement: Prevent ventilator-associated pneumonia. Institute for Healthcare Improvement. 2012. http://www.ihi.org/knowledge/Pages/Changes/ImplementtheVentilatorBundle.aspx; Accessed 9 Dec 2013.
citation: Blitt CD, Gutman HL, Cohen DD, Weisman H, Dillon JB. "Silent" regurgitation and aspiration during general anesthesia. Anesth Analg. 1970 Sep-Oct;49(5):707-13. No abstract available.
PMID: 5534428
citation: McEwen DR. Intraoperative positioning of surgical patients. AORN J. 1996 Jun;63(6):1059-63, 1066-79; quiz 1080-6. doi: 10.1016/s0001-2092(06)63293-6.
PMID: 8771317
citation: Adedeji R, Oragui E, Khan W, Maruthainar N. The importance of correct patient positioning in theatres and implications of mal-positioning. J Perioper Pract. 2010 Apr;20(4):143-7. doi: 10.1177/175045891002000403.
PMID: 20446625
citation: Smith KA. Positioning principles. An anatomical review. AORN J. 1990 Dec;52(6):1196-202, 1204, 1206-8. doi: 10.1016/s0001-2092(07)69197-2. No abstract available.
PMID: 2278485
citation: Mulier JP, Dillemans B, Van Cauwenberge S. Impact of the patient's body position on the intraabdominal workspace during laparoscopic surgery. Surg Endosc. 2010 Jun;24(6):1398-402. doi: 10.1007/s00464-009-0785-8. Epub 2010 Jan 7.
PMID: 20054583
citation: Abdulla S. Pulmonary aspiration in perioperative medicine. Acta Anaesthesiol Belg. 2013;64(1):1-13.
PMID: 23767172
citation: Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth. 1999 Sep;83(3):453-60. doi: 10.1093/bja/83.3.453. No abstract available.
PMID: 10655918
citation: Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001 Aug;93(2):494-513. doi: 10.1097/00000539-200108000-00050.
PMID: 11473886
citation: Kalinowski CP, Kirsch JR. Strategies for prophylaxis and treatment for aspiration. Best Pract Res Clin Anaesthesiol. 2004 Dec;18(4):719-37. doi: 10.1016/j.bpa.2004.05.008.
PMID: 15460555
responsible party type: Sponsor-Investigator
investigator affiliation: Mercy Health Ohio
investigator full name: C. Michael Dunham
investigator title: Research Associate, St. Elizabeth Youngstown Hospital
mesh term: Respiratory Aspiration
mesh term: Hypoxia
mesh term: Anesthetics
sharing ipd: No