The use of position during critical illness: current practice and review of the literature

Evans, David

doi:10.1016/s1036-7314(94)70675-5

Cited by 28 publications

(15 citation statements)

References 22 publications

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“…Severity of illness as measured by the APACHE II score recorded in the first 24 hours of ICU admission had previously been shown to be associated with lower backrest elevation. 13 Our study did not show an association between backrest elevation and APACHE II score. Arguably the SOFA max score, which takes into account daily ratings of organ failure, 32 is a more sensitive predictor of head-of-bed elevation than is a single measurement of illness severity recorded early in the patient's ICU admission.…”

Section: Discussioncontrasting

confidence: 70%

“…13 Our results, however, reflect a backrest elevation below the level recommended for prevention of VAP. [9][10][11] Current guidelines recommend 30º to 45º of backrest elevation, although high-level evidence exists only for 45º or greater semirecumbency.…”

Section: Discussionmentioning

confidence: 53%

“…12 Several clinical practice surveys, conducted before the release of VAP prevention guidelines endorsed by various professional societies, [9][10][11] indicated that semirecumbent positioning for VAP prevention was inconsistently implemented into clinical practice. 4,[13][14][15] Potential reasons for the failure to use semirecumbent positioning for patients include ambiguity of decisionmaking responsibility for setting semirecumbency targets, contraindications to backrest elevation, use of alternative positions, lack of resources, lack of awareness of semirecumbent positioning as a strategy for preventing VAP, and concerns about safety, including risk of formation of decubitus ulcers. 16 Results of earlier observational studies indicate that patient variables, including hemodynamic stability, 15,17 weaning status, 16 feeding status, 15,17 and severity of illness, 13,18 also may influence patients' positioning.…”

mentioning

confidence: 99%

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Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Rose¹,

Baldwin²,

Crawford³

et al. 2010

American Journal of Critical Care

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Background Positioning of patients is a modifiable risk factor for ventilator-associated pneumonia. Current guidelines for prevention of ventilator-associated pneumonia recommend semirecumbency at 30º, with 45º preferable unless contraindicated. Objective To assess the use of semirecumbency for ventilator patients in Australian and New Zealand intensive care units. Methods In a multicenter, observational study, backrest elevation, mean arterial pressure, use of inotropic agents, enteral feeding, and weaning status were recorded 3 times per day by using a predetermined randomization schedule for 7 consecutive days (maximum 21 observation episodes). Severity of illness was recorded daily by using the Sepsis-Related Organ Failure Assessment (SOFA) score. Results Measurements (n = 2112) were recorded for 371 ventilator patients in 32 intensive care units. Backrest elevation at ≥45º was noted for 112 of 2112 (5.3%; 95% confidence interval [CI], 4.3-6.3) measurements; elevation ≥30º but <45º for 472 of 2112 (22.3%; 95% CI, 20.6-24.1). Contraindications to semirecumbency were noted during 447 measurements. Increased backrest elevation occurred during enteral feeding (2.2º, P < .001) and weaning (3.1º, P < .001). Decreased backrest elevation was associated with inotropic support (2.8º, P < .001), decreased mean arterial pressure (0.7º/10 mm Hg, P < .001), and organ failure (0.5º/1-point increment in SOFA max score, P < .001). For measurements recorded with no contraindication to semirecumbency, weaning status (P = .003) and SOFA max score (P = .008) remained associated with the degree of backrest elevation. Conclusions The findings of this multicenter, observational study suggest that backrest elevation was less than recommended and was influenced by clinical practices and patient condition.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 53%

mentioning

confidence: 99%

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Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Rose¹,

Baldwin²,

Crawford³

et al. 2010

American Journal of Critical Care

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“…15,47,48 (preferably ≥ 30º) as long as it does not conflict with medical interventions, patients' wishes, or nursing tasks.…”

Section: Aspiration Guidelinesmentioning

confidence: 99%

“…For example, Evans 48 found a significant negative correlation (r 2 =-0.17) between scores on the Acute Physiology and Chronic Health Evaluation II and HOB elevation in 113 critically ill patients. Evans 48 also reported that patients receiving mechanical ventilation had a lower mean HOB elevation than did self-ventilating patients (19º vs 32º).…”

Section: Evidence To Support a Low Hob Elevation To Prevent Pressure mentioning

confidence: 99%

Head-of-Bed Elevation in Critically Ill Patients: A Review

Metheny

Frantz

2013

Critical Care Nurse

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Clinicians are confused by conflicting guidelines about the use of head-of-bed elevation to prevent aspiration and pressure ulcers in critically ill patients. Research-based information in support of guidelines for head-of-bed elevation to prevent either condition is limited. However, positioning of the head of the bed has been studied more extensively for the prevention of aspiration than for the prevention of pressure ulcers, especially in critically ill patients. More research on pressure ulcers has been conducted in healthy persons or residents of nursing homes than in critically ill patients. Thus, the optimal elevation for the head of the bed to balance the risks for aspiration and pressure ulcers in critically ill patients who are receiving mechanical ventilation and tube feedings is unknown. Currently available information provides some indications of how to position patients; however, randomized controlled trials where both outcomes are evaluated simultaneously at various head-of-bed positions are needed.

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Lateral positioning for critically ill adult patients

Hewitt

Bucknall

Glanville³

2008

Cochrane Database of Systematic Reviews

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We aim to assess the effect of the lateral position compared to other body positions on patient outcomes (mortality, morbidity and clinical adverse events during and following positioning) in critically ill adult patients. We will examine the single use of the lateral position (that is on the right or left side) and repeat use of the lateral position(s) in a positioning schedule (that is lateral positioning). We plan to undertake subgroup analysis for primary disease and condition, severity of illness, the presence of assisted ventilation and angle of lateral rotation.

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The use of position during critical illness: current practice and review of the literature

Cited by 28 publications

References 22 publications

Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Head-of-Bed Elevation in Critically Ill Patients: A Review

Lateral positioning for critically ill adult patients

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