Role of head‐of‐bed elevation in preventing ventilator‐associated pneumonia bed elevation and pneumonia
Background Elevating the head of bed (HOB) to 30° to 45° is an evidence‐based recommendation to prevent ventilator‐associated pneumonia (VAP). However, the available scientific data are inconclusive regarding the optimal degree of HOB elevation which is safe and effective for mechanically ventilated...
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| Veröffentlicht in: | Nursing in critical care 2022-09, Vol.27 (5), p.635-645 |
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| creator | Güner, Canan Kaş Kutlutürkan, Sevinç |
| description | Background
Elevating the head of bed (HOB) to 30° to 45° is an evidence‐based recommendation to prevent ventilator‐associated pneumonia (VAP). However, the available scientific data are inconclusive regarding the optimal degree of HOB elevation which is safe and effective for mechanically ventilated patients.
Aims and objectives
To investigate the impact a of semirecumbent position at 30° and 45°on the development of VAP as compared with aHOB elevation to |
| doi_str_mv | 10.1111/nicc.12633 |
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Elevating the head of bed (HOB) to 30° to 45° is an evidence‐based recommendation to prevent ventilator‐associated pneumonia (VAP). However, the available scientific data are inconclusive regarding the optimal degree of HOB elevation which is safe and effective for mechanically ventilated patients.
Aims and objectives
To investigate the impact a of semirecumbent position at 30° and 45°on the development of VAP as compared with aHOB elevation to <30°.
Methods
A 5‐day, single centre, prospective, randomized, controlled, parallel group, three‐arm study was conducted in adult patients on mechanical ventilation staying in the intensive care unit. Patients were randomly placed in <30°, 30°, or 45° HOB elevation position on the day of intubation and followed up for 5 days. They were assessed in terms of the development of microbiologically confirmed VAP (by the culture of endotracheal aspirate) over the study period.
Results
Sixty patients (20 in each arm) completed the study. VAP occurred in 55%, 25%, and 20% of patients in the HOB elevation to <30°, 30°, and 45°study arms, respectively. The frequency of VAP was significantly lower in the 45° compared with the <30° study arm (P = .022); there were no significant differences between the <30° and 30° as well as the 45° and 30° study groups. Unlike the frequency of VAP, the timing of the VAP (early or late) was not dependent on the degree of HOB elevation (P = .703).
Conclusions
Keeping the mechanically ventilated patients in a semirecumbent position as close to 45°as possible should be the goal to prevent the development of VAP. The backrest elevation <30° should be avoided unless medically indicated.
Relevance to clinical practice
The study results reaffirm the crucial role of patient positioning, an essential nursing care intervention, in preventing VAP. Intensive care nurses can contribute to improving the VAP rates and outcomes by placing and keeping the patients in the correct position.]]></description><identifier>ISSN: 1362-1017</identifier><identifier>EISSN: 1478-5153</identifier><identifier>DOI: 10.1111/nicc.12633</identifier><identifier>PMID: 33884691</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>head of bed elevation ; Intensive care ; intensive care unit ; mechanical ventilation ; nursing care ; Pneumonia ; ventilator associated pneumonia ; Ventilators</subject><ispartof>Nursing in critical care, 2022-09, Vol.27 (5), p.635-645</ispartof><rights>2021 British Association of Critical Care Nurses.</rights><rights>2022 British Association of Critical Care Nurses</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3573-182e2af009aff5ab8aabefcb1e489de7780706a3da8edf62ff5ae3e4f236541c3</citedby><cites>FETCH-LOGICAL-c3573-182e2af009aff5ab8aabefcb1e489de7780706a3da8edf62ff5ae3e4f236541c3</cites><orcidid>0000-0003-1637-0690</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fnicc.12633$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fnicc.12633$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33884691$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Güner, Canan Kaş</creatorcontrib><creatorcontrib>Kutlutürkan, Sevinç</creatorcontrib><title>Role of head‐of‐bed elevation in preventing ventilator‐associated pneumonia bed elevation and pneumonia</title><title>Nursing in critical care</title><addtitle>Nurs Crit Care</addtitle><description><![CDATA[Background
Elevating the head of bed (HOB) to 30° to 45° is an evidence‐based recommendation to prevent ventilator‐associated pneumonia (VAP). However, the available scientific data are inconclusive regarding the optimal degree of HOB elevation which is safe and effective for mechanically ventilated patients.
Aims and objectives
To investigate the impact a of semirecumbent position at 30° and 45°on the development of VAP as compared with aHOB elevation to <30°.
Methods
A 5‐day, single centre, prospective, randomized, controlled, parallel group, three‐arm study was conducted in adult patients on mechanical ventilation staying in the intensive care unit. Patients were randomly placed in <30°, 30°, or 45° HOB elevation position on the day of intubation and followed up for 5 days. They were assessed in terms of the development of microbiologically confirmed VAP (by the culture of endotracheal aspirate) over the study period.
Results
Sixty patients (20 in each arm) completed the study. VAP occurred in 55%, 25%, and 20% of patients in the HOB elevation to <30°, 30°, and 45°study arms, respectively. The frequency of VAP was significantly lower in the 45° compared with the <30° study arm (P = .022); there were no significant differences between the <30° and 30° as well as the 45° and 30° study groups. Unlike the frequency of VAP, the timing of the VAP (early or late) was not dependent on the degree of HOB elevation (P = .703).
Conclusions
Keeping the mechanically ventilated patients in a semirecumbent position as close to 45°as possible should be the goal to prevent the development of VAP. The backrest elevation <30° should be avoided unless medically indicated.
Relevance to clinical practice
The study results reaffirm the crucial role of patient positioning, an essential nursing care intervention, in preventing VAP. Intensive care nurses can contribute to improving the VAP rates and outcomes by placing and keeping the patients in the correct position.]]></description><subject>head of bed elevation</subject><subject>Intensive care</subject><subject>intensive care unit</subject><subject>mechanical ventilation</subject><subject>nursing care</subject><subject>Pneumonia</subject><subject>ventilator associated pneumonia</subject><subject>Ventilators</subject><issn>1362-1017</issn><issn>1478-5153</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp90clKxTAUBuAgivPGB5CCGxGqGZo2XcrFCURBdB1O2xONtMm1aRV3PoLP6JOY61VRFwYyQL78CTmEbDG6z2I7cLau9xnPhVggqywrVCqZFItxLXKeMsqKFbIWwj2lnEoplsmKEEpleclWSXflW0y8Se4QmreXV2_iUGGTYIuPMFjvEuuSaY-P6AbrbpOPuYXB9xFCCL62MEQ_dTh23llIfp8G92NvgywZaANufs7r5Ob46Hpymp5fnpxNDs_TWshCpExx5GAoLcEYCZUCqNDUFcNMlQ0WhaIFzUE0oLAxOZ8hFJgZLnKZsVqsk9157rT3DyOGQXc21Ni24NCPQXPJciXKrGSR7vyh937sXXyd5vESqVTsUe3NVd37EHo0etrbDvpnzaieFUHPiqA_ihDx9mfkWHXYfNOvX4-AzcGTbfH5nyh9cTaZzEPfARwFlpk</recordid><startdate>202209</startdate><enddate>202209</enddate><creator>Güner, Canan Kaş</creator><creator>Kutlutürkan, Sevinç</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1637-0690</orcidid></search><sort><creationdate>202209</creationdate><title>Role of head‐of‐bed elevation in preventing ventilator‐associated pneumonia bed elevation and pneumonia</title><author>Güner, Canan Kaş ; Kutlutürkan, Sevinç</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3573-182e2af009aff5ab8aabefcb1e489de7780706a3da8edf62ff5ae3e4f236541c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>head of bed elevation</topic><topic>Intensive care</topic><topic>intensive care unit</topic><topic>mechanical ventilation</topic><topic>nursing care</topic><topic>Pneumonia</topic><topic>ventilator associated pneumonia</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Güner, Canan Kaş</creatorcontrib><creatorcontrib>Kutlutürkan, Sevinç</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Nursing in critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Güner, Canan Kaş</au><au>Kutlutürkan, Sevinç</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of head‐of‐bed elevation in preventing ventilator‐associated pneumonia bed elevation and pneumonia</atitle><jtitle>Nursing in critical care</jtitle><addtitle>Nurs Crit Care</addtitle><date>2022-09</date><risdate>2022</risdate><volume>27</volume><issue>5</issue><spage>635</spage><epage>645</epage><pages>635-645</pages><issn>1362-1017</issn><eissn>1478-5153</eissn><abstract><![CDATA[Background
Elevating the head of bed (HOB) to 30° to 45° is an evidence‐based recommendation to prevent ventilator‐associated pneumonia (VAP). However, the available scientific data are inconclusive regarding the optimal degree of HOB elevation which is safe and effective for mechanically ventilated patients.
Aims and objectives
To investigate the impact a of semirecumbent position at 30° and 45°on the development of VAP as compared with aHOB elevation to <30°.
Methods
A 5‐day, single centre, prospective, randomized, controlled, parallel group, three‐arm study was conducted in adult patients on mechanical ventilation staying in the intensive care unit. Patients were randomly placed in <30°, 30°, or 45° HOB elevation position on the day of intubation and followed up for 5 days. They were assessed in terms of the development of microbiologically confirmed VAP (by the culture of endotracheal aspirate) over the study period.
Results
Sixty patients (20 in each arm) completed the study. VAP occurred in 55%, 25%, and 20% of patients in the HOB elevation to <30°, 30°, and 45°study arms, respectively. The frequency of VAP was significantly lower in the 45° compared with the <30° study arm (P = .022); there were no significant differences between the <30° and 30° as well as the 45° and 30° study groups. Unlike the frequency of VAP, the timing of the VAP (early or late) was not dependent on the degree of HOB elevation (P = .703).
Conclusions
Keeping the mechanically ventilated patients in a semirecumbent position as close to 45°as possible should be the goal to prevent the development of VAP. The backrest elevation <30° should be avoided unless medically indicated.
Relevance to clinical practice
The study results reaffirm the crucial role of patient positioning, an essential nursing care intervention, in preventing VAP. Intensive care nurses can contribute to improving the VAP rates and outcomes by placing and keeping the patients in the correct position.]]></abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>33884691</pmid><doi>10.1111/nicc.12633</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-1637-0690</orcidid></addata></record> |
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| ispartof | Nursing in critical care, 2022-09, Vol.27 (5), p.635-645 |
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| subjects | head of bed elevation Intensive care intensive care unit mechanical ventilation nursing care Pneumonia ventilator associated pneumonia Ventilators |
| title | Role of head‐of‐bed elevation in preventing ventilator‐associated pneumonia bed elevation and pneumonia |
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