• Background Oral care and head-of-bed elevation are interventions to decrease risk of aspiration pneumonia in hospitalized patients. In a previous study, nurses’ self-reports of how often they performed oral care did not match documented provision of such care. • Objectives To replicate the original study and estimate instrument reliability. • Methods A cross-sectional design was used, and survey data from nursing personnel and bedside observational data from 9 intensive care units were collected. • Results A total of 181 surveys (47%) were returned, and data were collected from 436 bedsides. Reported frequencies of oral care and use of oral care products differed between nonintubated and intubated patients (P<.001). The mean documented frequency of oral care for nonintubated patients was 1.8 (SD 1.5); self-reported frequency was 3 (SD 2.4). The mean documented frequency of oral care for intubated patients was 3.3 (SD 1.8); self-reported frequency was 4.2 (SD 2.1). Documented oral care frequency differed by unit (P = .006) and intubation status (P < .001). Mean observed head-of-bed position was 38° (SD 24°) for nonintubated patients and 23° (SD 12°) for intubated patients (P < .001). Intubation status, but not unit, affected observed head-of-bed position (P < .001). Three survey items had adequate reliability evidence (r=0.70). Interrater reliability for bedside data collection was 96% or greater. • Conclusions Despite inadequate estimates of survey reliability, findings generally were comparable to results of the original study; nurses report more frequent oral care than is documented. Intensive care nurses elevate the head of patients’ beds in accordance with self-reports.

Turning critically ill, mechanically ventilated patients every 2 hours is a fundamental nursing intervention to reduce the negative impact of prolonged immobility from preventable pulmonary complications such as ventilator-associated pneumonia and atelectasis. Unfortunately, when coupled with positive pressure ventilation, the benefits of turning may come at the expense of cardiovascular function. Clinicians should closely monitor the hemodynamic response to turning mechanically ventilated patients, and if compromise is observed, the degree and duration of compromise may provide guidance to the appropriate intervention.

No abstract

In this article, we illustrate a new method for random selection and random assignment that we developed in a pilot study for a randomized clinical trial. The randomization database is supported by a commonly available spreadsheet. Formulas were written for randomizing participants and for creating a "shadow" system to verify integrity of the randomization. Advantages of this method are that it is easy to use, effective, and portable, allowing it to be shared among multiple investigators at multiple study sites. Clinical researchers may find the method useful for research projects that are pilot studies or conducted with limited funding.

Purpose To estimate effect sizes for a trial to compare preventable pulmonary complications (PPCs), turning-related adverse events, mechanical ventilation duration, intensive care unit (ICU) length of stay, and ICU mortality between patients randomized to 2-hourly manual or continuous automated lateral rotation. Methods Randomized controlled trial pilot study with 15 patients selected randomly from eligible medical-surgical ICU patients from 2 tertiary hospitals and assigned randomly to the manualturn or automated-turn protocol for up to 7 consecutive days. A radiologist blinded to group and site assessed serial chest radiographs for PPCs. Repeated-measures analysis with linear mixed models was used to estimate change in PPC score, and Wilcoxon rank sum or Fisher exact test was used to compare group differences in the secondary outcomes. Results Of 16 patients enrolled, 12 (75%) completed the study. Data from 15 patients, 7 manual turn and 8 automated turn, were analyzed. Between-group differences in PPC incidence (67% overall), change in PPC score (β = 0.15, manual turn and β = -0.44, automated turn), and secondary outcomes were not significant (P > .05). Standardized effect sizes were small to moderate for the outcome variables. A sample size of 54 patients would be needed to detect statistically significant between-group differences in PPC over time. Conclusions The incidence of PPCs in adult patients receiving mechanical ventilation in a medical-surgical ICU was high. Automated turning decreased PPCs with time but had little effect on secondary outcomes. Safety outcomes were not substantially different between groups. A modest efficacy effect supported reduced PPCs with automated turning to the lateral position.

No abstract