Semi‐recumbent position for the prevention of ventilator‐associated pneumonia in adults requiring mechanical ventilation

Ventilator-associated pneumonia (VAP) is a serious infection that increases mortality, hospital stay duration, and healthcare costs in critically ill patients. This 2025 Cochrane systematic review includes 48 randomized controlled trials with a total of 7955 participants. Semi-recumbent positioning compared to supine positioning significantly reduces clinically suspected VAP (RR 0.42), but has no significant effect on mortality or hospital stay duration. A 30° to 45° angle compared to less than 30° reduces VAP (RR 0.48) but increases the risk of pressure ulcers. A 40° to 45° angle compared to 30° has no significant effect on clinically suspected VAP but may reduce microbiologically confirmed VAP. The results suggest that semi-recumbent positioning has a protective effect against VAP, but with potential adverse effects.