The effect of high lateral position on antibiotic exposure duration in patients with severe traumatic brain injury: a retrospective observational cohort study

Background Patients with severe traumatic brain injury (sTBI) often require mechanical ventilation and have a high incidence of aspiration pneumonia, leading to prolonged antibiotic exposure. This study assesses the association between high lateral position (HLP) and antibiotic exposure duration in sTBI patients, and reports on safety and feasibility. Methods This study retrospectively collected data from 138 patients with severe traumatic brain injury complicated by aspiration pneumonia who were treated in the intensive care unit from January 2023 to June 2024. Patients were divided into two groups based on whether they received high lateral position (HLP) therapy: the HLP group ( n = 45) and the non-HLP group ( n = 93). Univariate and multivariate linear regression analyses were used to identify independent risk factors associated with the duration of antibiotic use, and the association between HLP therapy and antibiotic use duration was evaluated by comparing the two groups. Results Patients who received HLP had a shorter duration of antibiotic use; both univariate and multivariate regression analyses suggested an association between HLP and shorter duration of use. Univariate linear regression analysis showed that HLP, chronic obstructive pulmonary disease (COPD), arterial oxygen partial pressure, and oxygenation index were all associated with the duration of antibiotic use. Multivariate linear regression analysis further confirmed that HLP was independently associated with a shorter duration of antibiotic use ( β = −2.58; 95% CI, −4.44 to −0.71; p = 0.008), while COPD was associated with a longer duration of use (β = 8.78; 95% CI, 4.42 to 13.13; p < 0.001). Conclusion In this retrospective cohort, HLP was associated with a shorter duration of antibiotic exposure and showed trends toward fewer days of mechanical ventilation and a lower tracheostomy rate. Given the nonrandomized design and potential residual confounding, these findings are exploratory and should be confirmed in prospective randomized studies.