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Crit Care. 2011;15(2):R111. doi: 10.1186/cc10135. Epub 2011 Apr 11.

An evidence-based recommendation on bed head elevation for mechanically ventilated patients.

Author information

  • 1Leiden University Medical Center, Dutch Working Party Infection Prevention, C7-130, Postbus 9600, 2300 RC Leiden, Germany. bsnielweise@gmail.com

Abstract

INTRODUCTION:

A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one.

METHODS:

A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure.

RESULTS:

Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45° bed head elevation was effective or harmful with regard to the occurrence of clinically suspected VAP, microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45° elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45° position and preferably to a ≥ 30° position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes.

CONCLUSIONS:

Although the review failed to prove clinical benefits of bed head elevation, experts prefer this position in ventilated patients. They made clear that the position of a ventilated patient in bed depended on many determinants. Therefore, given the scientific uncertainty about the benefits and harms of a semi-upright position, this position could only be recommended as the preferred position with the necessary restrictions.

Comment in

PMID:
21481251
[PubMed - indexed for MEDLINE]
PMCID:
PMC3219392
Free PMC Article
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