scholarly journals Factors Associated with Head-of-Bed Elevation Compliance for Prevention of Ventilator-Associated Pneumonia

2014 ◽  
Vol 35 (5) ◽  
pp. 596-597 ◽  
Author(s):  
Hsin-Lan Lin ◽  
Li-Yu Yang ◽  
Chih-Cheng Lai
Keyword(s):  
Ventilator Associated Pneumonia ◽  
Factors Associated ◽  
Bed Elevation ◽  
Head Of Bed Elevation

Clinicians’ Perception of Head-of-Bed Elevation

2010 ◽  
Vol 19 (2) ◽  
pp. 164-167 ◽  
Author(s):  
Chad Hiner ◽  
Tomoyo Kasuya ◽  
Christine Cottingham ◽  
JoAnne Whitney
Keyword(s):  
Registered Nurses ◽  
Occupational Therapists ◽  
Simulated Patient ◽  
Ventilator Associated Pneumonia ◽  
Medical Assistants ◽  
Respiratory Therapists ◽  
Bed Elevation ◽  
Correct Angle ◽  
Head Of Bed Elevation

Background Head-of-bed elevation of 30° to 45° is important in preventing ventilator-associated pneumonia, but clinicians’ perception and determination of head-of-bed elevation are not widely reported.Objectives To (1) document the accuracy of clinicians’ perception of head-of-bed elevation, (2) document methods clinicians use to determine the head-of-bed angle, and (3) assess knowledge of recommended head-of-bed elevation.Methods Clinicians (n = 175) viewed a simulated patient with head of bed elevated 30° and elevation gauge concealed. They answered 3 questions: What is the level of the head of the bed? What head-of-bed elevation is associated with decreased incidence of ventilator-associated pneumonia? When providing care, how do you routinely determine the head-of-bed elevation?Results Fifty percent of 89 registered nurses and 53% of 39 physicians identified head-of-bed elevation correctly (±5°). Head-of-bed elevation was perceived accurately by 86% of 21 respiratory therapists, 63% of 16 medical assistants, and 50% of 10 physical/occupational therapists. Ninety-five percent of nurses and respiratory therapists, 79% of physicians, 90% of physical/occupational therapists, and 46% of medical assistants correctly identified the head-of-bed angle associated with decreases in occurrence of ventilator-associated pneumonia. Techniques for determining the angle varied; 58% of respondents reported using the gauge.Conclusions Head-of-bed angle was perceived correctly by 50% to 86% of clinicians. Nurses tended to underestimate the angle, whereas other clinicians tended to overestimate. Nurses, respiratory therapists, and physical/occupational therapists showed the best understanding of the correct angle for minimizing occurrence of ventilator-associated pneumonia. Elevation gauges were most often used to determine the angle.

scholarly journals Evaluation of a bundle to prevent ventilator-associated pneumonia in an intensive care unit

2014 ◽  
Vol 23 (3) ◽  
pp. 744-750 ◽  
Author(s):  
Sabrina Guterres da Silva ◽  
Raquel Kuerten de Salles ◽  
Eliane Regina Pereira do Nascimento ◽  
Kátia Cilene Godinho Bertoncello ◽  
Cibele D'Avila Kramer Cavalcanti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cuff Pressure ◽  
Oral Care ◽  
Ventilator Associated Pneumonia ◽  
Endotracheal Suctioning ◽  
Cross Sectional ◽  
Bed Elevation ◽  
Head Of Bed Elevation ◽  
Expected Compliance

We aimed at evaluating compliance with a bundle to prevent ventilator-associated pneumonia in an Intensive Care Unit. It is a quantitative, descriptive and cross-sectional study, conducted in a public hospital in the state of Santa Catarina. Data were collected in July and August of 2012. The sample consisted of 1,146 observations of the four elements that compose the bundle (head of bed elevation between 30-45°; endotracheal suctioning; cuff pressure between 20-30 cmH2O; and oral care with 0.12% chlorhexidine). Expected compliance was equal to a positivity rate ≥80%. Data analysis revealed overall bundle compliance of 794 (69.2%). When analyzed separately, two practices presented expected compliance (84.7%): oral care and suctioning. Head of bed elevation had the lowest compliance (55.5%), followed by cuff pressure (61.8%). We observed the need for strategies that promote the quality of all the elements that compose the bundle in order for its use to be effective.

Physiological Rationale and Current Evidence for Therapeutic Positioning of Critically Ill Patients

2009 ◽  
Vol 20 (3) ◽  
pp. 228-240
Author(s):  
Karen L. Johnson ◽  
Tim Meyenburg
Keyword(s):  
Critically Ill ◽  
Patient Outcomes ◽  
Critically Ill Patients ◽  
Bed Rest ◽  
Current Evidence ◽  
Kinetic Therapy ◽  
Bed Elevation ◽  
Continuous Lateral Rotation ◽  
Head Of Bed Elevation ◽  
Improve Patient

Prolonged bed rest is common in critically ill patients, and therapeutic positioning is important to prevent further complications and to improve patient outcomes. Nurses use therapeutic positioning to prevent complications of immobility. This article reviews therapeutic positions including stationary positions (supine, semirecumbent with head of bed elevation, lateral, and prone) and active repositioning (manual, continuous lateral rotation, and kinetic therapy). The physiological rationale and current evidence for each position are described. Applicable evidence-based practice guidelines are summarized. Special considerations for therapeutic positioning of critically ill obese and elderly patients are also discussed.

Cerebrovascular Dynamics With Head-of-Bed Elevation in Patients With Mild or Moderate Vasospasm After Aneurysmal Subarachnoid Hemorrhage

2006 ◽  
Vol 15 (2) ◽  
pp. 206-216 ◽  
Author(s):  
Patricia A. Blissitt ◽  
Pamela H. Mitchell ◽  
David W. Newell ◽  
Susan L. Woods ◽  
Basia Belza
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Repeated Measures ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Bed Rest ◽  
P Values ◽  
Repeated Measures Design ◽  
Bed Elevation ◽  
Repeated Measures Analysis ◽  
Head Of Bed Elevation

• Background In patients with aneurysmal subarachnoid hemorrhage, elevation of the head of the bed during vasospasm has been limited in an attempt to minimize vasospasm or its sequelae or both. Consequently, some patients have remained on bed rest for weeks. • Objectives To determine how elevations of the head of the bed of 20° and 45° affect cerebrovascular dynamics in adult patients with mild or moderate vasospasm after aneurysmal subarachnoid hemorrhage and to describe the response of mild or moderate vasospasm to head-of-bed elevations of 20° and 45° with respect to variables such as grade of subarachnoid hemorrhage and degree of vasospasm. • Methods A within-patient repeated-measures design was used. The head of the bed was positioned in the sequence of 0°-20°-45°-0° in 20 patients with mild or moderate vasospasm between days 3 and 14 after aneurysmal subarachnoid hemorrhage. Continuous transcranial Doppler recordings were obtained for 2 to 5 minutes after allowing approximately 2 minutes for stabilization in each position. • ResultsNo patterns or trends indicated that having the head of the bed elevated increases vasospasm. As a group, there were no significant differences within patients at the different positions of the head of the bed. Utilizing repeated-measures analysis of variance, P values ranged from .34 to .97, well beyond .05. No neurological deterioration occurred. • Conclusions In general, elevation of the head of the bed did not cause harmful changes in cerebral blood flow related to vasospasm.

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