Effects of tracheal orientation on development of ventilator-associated pneumonia: An experimental study

Alberto Zanella, Massimo Cressoni, Myra Epp, Viktoria Hoffmann, Mario Stylianou, Theodor Kolobow

Research output: Contribution to journalArticlepeer-review


Abstract Purpose: Orientation of the trachea and tracheal tube below horizontal may prevent aspiration of oropharyngeal secretions into the lungs, which is a pivotal pathway in the pathogenesis of ventilator-associated pneumonia (VAP). The incidence of VAP was evaluated in swine with orientation of trachea and tracheal tube above horizontal (model of semirecumbent position, currently recommended in patients) and below horizontal. Methods: Twenty-six mini-pigs were randomized into four groups: (A) eight mechanically ventilated with orientation of trachea 45above horizontal for 72 h. In the remaining groups (B, C, D) the trachea was oriented 10below horizontal, with (B) six mechanically ventilated for 72 h, (C) six mechanically ventilated for 72 h with enteral feeding, and (D) six mechanically ventilated for 168 h with enteral feeding. At the end of the study period, all pigs were sacrificed and the clinical diagnosis of VAP was microbiologically evaluated. No antibiotics were administered. Results: All eight pigs kept orientated with the trachea 45above horizontal developed VAP and respiratory failure (PaO2/ FiO2 = 132 ± 139 mmHg) with a median of 5.5 pulmonary lobes out of 6 colonized with average colonization of 9.3 9 107 CFU/g. None of the 18 pigs kept oriented with the trachea below horizontal developed VAP; 16 had sterile lungs, while 2, ventilated for 7 days, developed a low level of colonization. Conclusions: Orientation of the trachea above horizontal was uniformly associated with VAP and respiratory failure; positioning the trachea below horizontal consistently prevented development of VAP.

Original languageEnglish
Pages (from-to)677-685
Number of pages9
JournalIntensive Care Medicine
Issue number4
Publication statusPublished - Apr 2012


  • Artificial/adverse effects
  • Intratracheal/adverse effects Respiratory tract infections/ prevention and control Aspiration/prevention and control
  • Intubation Postural drainage
  • Mechanical ventilation
  • Nosocomial infections
  • Pigs
  • Pneumonia Ventilator-associated pneumonia Semirecumbent position
  • Pulmonary
  • Respiration

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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