The Effect of High Lateral Position on Antibiotic Exposure Duration in Patients with Severe Traumatic Brain Injury: A Retrospective Observational Cohort Study

Patients with severe traumatic brain injury (sTBI) frequently require mechanical ventilation and develop aspiration pneumonia, leading to prolonged antibiotic use. This study evaluates whether High Lateral Position (HLP) reduces antibiotic exposure duration in sTBI patients. Data from 138 mechanically ventilated sTBI patients with aspiration pneumonia (January 2023–June 2024) were retrospectively analyzed. Patients were stratified into HLP (n = 45) and non-HLP (n = 93) groups. Linear regression models assessed associations between HLP and antibiotic exposure. HLP significantly reduced antibiotic duration (β=−2.58; 95% CI: −4.44 to − 0.71; P = 0.008) and mechanical ventilation days (7.0 vs. 9.0, P = 0.004). Chronic obstructive pulmonary disease (COPD) increased antibiotic exposure (β = 8.78; 95% CI: 4.42–13.13; P < 0.001). HLP also lowered tracheostomy rates (6.7% vs. 20.4%, P = 0.038). These findings suggest HLP optimizes secretion drainage and reduces pulmonary complications, offering a cost-effective strategy to mitigate antibiotic resistance.