To study the clinical effect of lateral prone position in the comprehensive prevention and control of hospital-acquired pneumonia(HAP) in elderly patients in ICU.

Using prospective randomized controlled clinical research methods, 41 elderly patients, including 24 males, 17 females, age 67-93 years old, average age (79.90±6.65) years old, who were admitted to our hospital from January 2016 to December 2017, had no trachea intubation during hospitalization and were not in the incubation period of pathogenic infections or had no pneumonia within the artificial airway 48 h were selected. All patients were divided into a semi-horizontal group (21 cases) and a side-prone group (20 cases) according to the random number table method. There were no statistically significant differences in gender, age, acute physiology and chronic health score (APACHEⅡ), degree of consciousness disorder [GCS score] and the use of acid and sedative drugs in the two groups (P>0.05). Both groups of patients were given nasal enteric nutrition, oral care (q6h), decompression stickers at pressure, chest physiotherapy, and airway temperature humidification, and they were required to suck sputum before changing body position. Semi-horizontal group: The head of the bed is kept elevated by 30 °- 45 °, and the angle between the horizontal axis and the bed surface is adjusted depending on the local pressure situation of every 1~2 h; Side prone position group: After leveling the head of the bed, the patient takes the side lying position, the face and chest are bent toward the bed surface, and the angle between the face and the bed surface≤90 °, alternating between the left and right sides of every 1~2 h. The respiratory indicators of the two groups of patients in the quiet state of 5 min after each class of nurses turned over for the first time were compared, including breathing frequency, pulse oxygen saturation(SpO2), oxygenation index, average daily phlegm intake, circulation index(heart rate, average arterial pressure) and overall HAP incidence, skin pressure sore incidence.

The average number of sputum aspiration per day in the patients with lateral prone position was lower than that in the semi-horizontal group [(3±3.2) times/day vs (6±3.3) times/day], SpO2[(92%±7.3%) vs (88%±6.5%)] and oxygenation index [(321±23) mmHg vs (280±33) mmHg] were higher than that in the semi-horizontal group, which were statistically significant (P<0.05). However, there was no significant difference in heart rate between the two groups (P>0.05). The incidence of HAP was 10.00% (2/20) in the lateral prone group, which was lower than that in the semi-lying group [38.09% (8/21)], and the difference was statistically significant (P<0.05). However, there was no statistical difference in the incidence of pressure ulcers between the two groups [10.00% (2/20) vs. 14.28% (3/21), P>0.05].

Compared with half decubitus position, lateral prone position is more favorable for reducing the incidence of HAP, improving respiratory function and alleviating pain in elderly ICU patients.