Semirecumbent positioning in ventilator-dependent patients: a multicenter, observational study.
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 back-rest 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.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada. louise.rose@utoronto.ca
Louise
L
Rose
Ian
I
Baldwin
Tom
T
Crawford
Rachael
R
Parke
D000368:Aged; D001315:Australia; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009520:New Zealand; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011187:Posture; D011446:Prospective Studies; D012121:Respiration, Artificial