Each position is equipped with foxholes, bunkers, covers, and if there is time, fire trenches that can be linked by communication trenches. The main element of every position is usually the defense areas or strongpoints of the defending elements connected by a unified system of fire and obstacles. Positions are, as a rule, set up by the engineers and form an integral part of deeply echeloned defense zones, in which they are distributed in a definite order along the front and in depth. Numerous other positions are formed from the basic one.Ī zone, or sector, of the terrain that troops are occupying or are preparing to occupy. In the first, the rounded arms are raised to the level of the diaphragm in the second, they are extended to either side at shoulder level and in the third, they are raised over the head. In the fifth, the feet are closed with the heel of one foot touching the toe of the other. In the fourth, the turned-out feet are parallel to each other and separated by a distance of one foot. In the third, the feet partially adjoin one another. In the second, the heels of the turned-out legs are placed the length of a foot apart. In the first, the feet, with heels touching, have the toes turned outward, forming a straight line on the floor. The positions determine the harmonious arrangement of the body in space, assure the proper execution of the dance step, and create the gracefulness and expressiveness of the dance. 2016 (1).Any one of several basic positions of the legs and arms in classical dance. Semi-recumbent position versus supine position for the prevention of ventilator associated pneumonia in adults requiring mechanical ventilation. Wang L, Li X, Yang Z, Tang X, Yuan Q, Deng L, et al. An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Niël-Weise BS, Gastmeier P, Kola A, Vonberg RP, Wille JC, van den Broek PJ. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. It remains uncertain which degrees of semi-recumbent position are optimal.Īrticle review prepared and submitted by Mireia Llaurado Serra on behalf of the N&AHP Section, ESICM.ġ. No adequate evidence is available to draw any definitive conclusion on other outcomes and the comparison of alternative semi-recumbent positions. However, the evidence is seriously limited with a high risk of bias. In reference to the methodological issues of the studies included, most of the studies had high risk of bias and 9 out of 10 did not report the adherence to the planned position, three monitored and corrected the body position and only one trial consistently monitored the average angle of head-of-bed elevation in the semi-recumbent position group which ranged far from the target.Īuthors concluded that semi-recumbent position (>30º) may reduce clinically suspected VAP compared to 0-10º supine position. They did not find any statistical differences in any other outcome. They concluded that semi-recumbent position (30 to 60º) significantly reduced the risk of clinically suspected VAP compared to 0-10º. Authors included 10 trials involving 878 participants. The outcomes evaluated were clinically suspected VAP, microbiologically confirmed VAP, ICU mortality, hospital mortality, length of ICU stay, length of hospital stay, duration of mechanical ventilation, antibiotic use and any adverse events. They included only randomised clinical trials comparing semi-recumbent versus supine position (up to 10º) or other degrees of positioning. (3), conducted a meta-analysis to evaluate the effectiveness and safety of semi-recumbent positioning versus supine positioning to prevent VAP in adults requiring mechanical ventilation. (2), intended to make a more individualised recommendation on positioning, but they could only conclude that “the recommendation should not be compelling, because the prevention of VAP is uncertain and the balance between benefits and harms is unknown… The experts recommend to elevate the head of bed the bed of mechanically ventilated patients to a 20 to 45º position and preferably in >30º position as long as it does not pose risks and conflicts with other nursing tasks, medical interventions or with patients’ wishes”. Semi-recumbent position is the elevation of the head-of-bed to 30-45º and it is recommended for the prevention of ventilator-associated pneumonia (VAP) with almost no absolute contraindications (1). Theoretically, it is applied in most or all intensive care units (ICUs) and it is considered a “standard of care” due to its advantages of being both convenient to implement and cost-free.
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