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Background: We recently completed a randomized clinical trial on the lateral-Trendelenburg position (LTP) vs. the semi-recumbent position (SRP) for the prevention of ventilator-associated pneumonia. Here we appraise hospital mortality risks associated with both interventions. Methods: We conducted a randomized, single-blind, controlled study in 17 European centers and 1 in North America. Critically ill, mechanically ventilated patients were randomized to be positioned in LTP or in the SRP. We evaluated all-cause hospital mortality. Also, in a post-hoc interaction exploratory analysis, we assessed mortality risks in patients with or without pulmonary infiltrates upon randomization. Results: A total of 2019 adult patients were screened. Three hundred ninety-five patients were randomized, 194 in LTP and 201 in SRP. Hospital Mortality was 31.3% and 37.1% in the SRP and LTP, respectively (RR 1.18, 95%CI 0.90-1.56, p=0.24). Multiple organ failure was the most common cause of death. Hospital mortality was lower in LTP patients without pulmonary infiltrates, in comparison with SRP, but a trend toward higher mortality was found in LTP patients with pulmonary infiltrates vs. SRP patients (RR with pulmonary infiltrates 1.42, 95% CI 1.01-2.00; RR without pulmonary infiltrates 0.83, CI 0.52-1.33, p=0.07 for heterogeneity). Conclusions: We found a trend toward higher hospital mortality rates in LTP patients with baseline pulmonary infiltrates. These results call for a comprehensive analysis of potential risks associated with LTP in this specific population.

Background: Pre-clinical studies confirmed benefits associated with the lateral-Trendelenburg position (LTP) vs. the semi-recumbent position (SRP) in the prevention of ventilator-associated pneumonia. Methods: We conducted a randomized, single-blind, multicenter, controlled study. Critically ill, mechanically ventilated patients were randomized to be positioned in LTP or SRP. Primary outcome was VAP incidence rate, based on quantitative bronchoalveolar lavage fluid culture ≥ 104 colony-forming units/mL. Secondary outcomes were duration of mechanical ventilation, intensive care unit (ICU) and hospital stays, and ICU/hospital/28-day mortality. Results: Three hundred ninety-five patients were randomized, 194 in LTP and 201 in SRP. The data safety monitoring board recommended stopping the study at the second interim analysis for low incidence of VAP in the control group, lack of benefits in any major secondary outcome and adverse events in the LTP group. The incidence of microbiologically confirmed VAP was 0.5% (1/194 patients) in patients positioned in LTP, and 4.0% (8/201 patients) in patients in SRP, risk ratio (RR) between groups 0.13, 95% confidence interval (CI) 0.02–1.03, p=0.04. Microbiologically confirmed VAP per 1000 ventilator days was 0.88 (95%CI 0.12-6.25) and 7.19 (95%CI 3.60-14.37) in the LTP and SRP, respectively, RR 0.12 (95%CI 0.01-0.91), p=0.02. No statistically significant between-group differences were observed in secondary outcomes. Conclusions: LTP potentially reduces risks of VAP, compared with the SRP. Yet, due to study limitations, further studies are mandatory to corroborate these findings in populations at higher risk of VAP.