Role of head-of-bed elevation in preventing ventilator-associated pneumonia bed elevation and pneumonia

Nurs Crit Care. 2021 Apr 21. doi: 10.1111/nicc.12633. Online ahead of print.


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.

PMID:33884691 | DOI:10.1111/nicc.12633