U.S. Department of Health and Human Services Agency for Health Care Policy and Research

Bergstrom, Nancy; Allman, Richard M.; Alvarez, Oscar M.; Bennett, Michele; Carlson, Carolyn E.; Frantz, Rita A.; Garber, Susan L.; Jackson, Bettie S.; Kaminski, Mitchell V.; Kemp, Mildred G.; Krouskop, Thomas A.; Lewis, Victor L; Maklebust, JoAnn; Margolis, David J.; Marvel, Elena M.; Reger, Steven I.; Rodeheaver, George T.; Yarkony, Gary M.; Chernoff, Ronni; Crow, Sue; Hadorn, David C.; Horsley, JoAnne; Miller, Henry I.; Susan, M; O'Brien, Vincent; Woolf, Steven H.

doi:10.1097/00006527-199521000-00003

Cited by 49 publications

(126 citation statements)

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“…A daily skin assessment is performed and recorded on each patient during the acute treatment phase. Universally accepted prevention strategies are used to prevent pressure ulcers (43)(44)(45). Pressure ulcers are staged and managed according to National Pressure Ulcer Advisory Panel recommendations (46)(47).…”

Section: The Ventilator Protocol Reflects the International Consensusmentioning

confidence: 99%

Clinical trial design—effect of prone positioning on clinical outcomes in infants and children with acute respiratory distress syndrome

Curley

Arnold

Thompson

et al. 2006

Journal of Critical Care

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Purpose-This paper describes the methodology of an ongoing clinical trial of prone positioning in pediatric patients with acute lung injury (ALI). Nonrandomized studies suggest that prone positioning improves oxygenation in patients with ALI/ARDS without the risk of serious iatrogenic injury. It is not known if these improvements in oxygenation result in improvements in clinical outcomes. A clinical trial was needed to answer this question. Materials and Methods-The pediatric prone study is a multi-center, randomized, non-crossover, controlled clinical trial. The trial is designed to test the hypothesis that at the end of 28 days, children with ALI treated with prone positioning will have more ventilator free days than children treated with supine positioning. Secondary endpoints include the time to recovery of lung injury, organ failure free days, functional outcome, adverse events, and mortality from all causes. Pediatric patients, 42 weeks post-conceptual age to 18 years of age, are enrolled within 48 hours of meeting ALI criteria. Patients randomized to the prone group are positioned prone within 4 hours of randomization and remain prone for 20 hours each day during the acute phase of their illness for a maximum of 7 days. Both groups are managed according to ventilator protocol, extubation readiness testing, and sedation protocols and hemodynamic, nutrition and skin care guidelines.

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Section: The Ventilator Protocol Reflects the International Consensusmentioning

confidence: 99%

Clinical trial design—effect of prone positioning on clinical outcomes in infants and children with acute respiratory distress syndrome

Curley

Arnold

Thompson

et al. 2006

Journal of Critical Care

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“…These lateral positions were chosen for investigation because after the S-30 position they are the most common positions assumed by critically ill patients and these positions are recommended to prevent the complications of immobility such as pressure ulcers. 32,40 The RL-30 and LL-30 positions yielded higher values than did the supine position when 25 mL of saline was instilled into the patient's bladder but not when 50 mL of saline was instilled (see Figure and Table). Interestingly, the LL-30 position was less sensitive to the volume of saline instilled than all other positions studied.…”

Section: Discussionmentioning

confidence: 99%

Measuring Intrabladder Pressure With the Head of the Bed Elevated 30º: Evidence to Support a Change in Practice

Shuster

Sekula

Kern

et al. 2011

American Journal of Critical Care

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Background A 30° head-of-bed elevation is recommended for most critically ill patients. Measuring intrabladder pressure with the patient in this position is controversial. Objective To assess the feasibility of measuring intrabladder pressure with a 30° head-of-bed elevation. Methods A prospective, randomized, and experimental study. Patients had intrabladder pressure measured first while positioned supine with a 30° head-of-bed elevation and 25 mL of saline instilled into the bladder and again after the patients were randomly repositioned to supine without any head-of-bed elevation (flat) or with a 30° head-of-bed elevation while supine or in right lateral or left lateral position with either 25, 50, or 200 mL of saline instilled into the patient's bladder. Results Intrabladder pressures measured with the patient in all 3 head-of-bed elevated positions were higher than pressures measured with patients supine and flat after instillation of 25 mL of saline into the bladder, but intrabladder pressure did not differ between the 30° head-of-bed elevated positions and the supine and flat positions when 50 or 200 mL of saline was instilled into the bladder. Two-way analysis of variance showed a significant interaction between volume of saline instilled (P = .05), patient's position (P = .007), and bladder instill volume and position interaction (P = .004). Conclusion It is feasible to measure intrabladder pressure with a 30° head-of-bed elevation, and that position could be an alternative to supine positioning of patients for measurement of intrabladder pressure.

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“…[14][15][16][17][18] In a 2009 report from Healthgrades that includes Medicare data from nearly 5000 nonfederally funded US hospitals, the number of pressure ulcers that formed in hospitalized Medicare beneficiaries between 2005 and 2007 was 445028 at an estimated acute care ancillary cost per case of $10845 or about $4826330000. 19 When primary admission costs are BACKGROUND Little has been published about how to prevent pressure ulcers in severely debilitated, immobile patients in intensive care units.…”

Section: Pressure Ulcer Prevention In High-risk Postoperative Cardiovmentioning

confidence: 99%

Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients

Jackson

McKenney²,

Drumm³

et al. 2011

Critical Care Nurse

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U.S. Department of Health and Human Services Agency for Health Care Policy and Research

Cited by 49 publications

References 0 publications

Clinical trial design—effect of prone positioning on clinical outcomes in infants and children with acute respiratory distress syndrome

Clinical trial design—effect of prone positioning on clinical outcomes in infants and children with acute respiratory distress syndrome

Measuring Intrabladder Pressure With the Head of the Bed Elevated 30º: Evidence to Support a Change in Practice

Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients

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