Background

VAP is the most common acquired infection in critically ill mechanically ventilated patients. According to current guidelines, intubated patients are kept in the semirecumbent position (30°) to prevent gastroesophageal reflux. Consistent laboratory evidence demonstrated increased VAP preventive efficacy when the trachea and tracheal tube were oriented slightly below horizontal to promote the outward drainage of oropharyngeal secretions, avoiding bacterial translocation from the oropharynx into the lungs. A tracheal orientation below horizontal can be achieved with the lateral-Trendelenburg position (-5°). A prospective multicenter randomized clinical trial showed the potential of the lateral-Trendelenburg position to reduce microbiologically confirmed VAP in critically ill intubated patients (Li Bassi G, Panigada M et al. Intensive Care Med. November 2017;43:1572– 84) and a new trial on a targeted population is on its way