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

Background Elevating the head of bed (HOB) to 30 degrees to 45 degrees 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 degrees and 45 degrees on the development of VAP as compared with aHOB elevation to 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 degrees, 30 degrees, or 45 degrees 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 degrees, 30 degrees, and 45 degrees study arms, respectively. The frequency of VAP was significantly lower in the 45 degrees compared with the <30 degrees study arm (P = .022); there were no significant differences between the <30 degrees and 30 degrees as well as the 45 degrees and 30 degrees 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 degrees as possible should be the goal to prevent the development of VAP. The backrest elevation <30 degrees 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.

Automated summary

The study compared the impact of 30 degrees and 45 degrees semi-recumbent positions on the development of VAP, finding a significant decrease in VAP frequency with the 45 degrees position. This highlights the importance of positioning mechanically ventilated patients as close to 45 degrees as possible to prevent VAP.