title: An evidence-based recommendation on bed head elevation for mechanically ventilated patients.
abstract: BACKGROUND
  A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one.
  
  
  METHODS
  A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure.
  
  
  RESULTS
  Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45° bed head elevation was effective or harmful with regard to the occurrence of clinically suspected VAP, microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45° elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45° position and preferably to a ≥ 30° position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes.
  
  
  CONCLUSIONS
  Although the review failed to prove clinical benefits of bed head elevation, experts prefer this position in ventilated patients. They made clear that the position of a ventilated patient in bed depended on many determinants. Therefore, given the scientific uncertainty about the benefits and harms of a semi-upright position, this position could only be recommended as the preferred position with the necessary restrictions.
authors.affiliation: Leiden University Medical Center, Dutch Working Party Infection Prevention, C7-130, Postbus 9600, 2300 RC Leiden, Germany. bsnielweise@gmail.com
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Niël-Weise
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Axel
authors.initials: A
authors.lastname: Kola
authors.forename: Ralf P
authors.initials: RP
authors.lastname: Vonberg
authors.forename: Jan C
authors.initials: JC
authors.lastname: Wille
authors.forename: Peterhans J
authors.initials: PJ
authors.lastname: van den Broek
mesh_terms: D001513:Beds; D019317:Evidence-Based Medicine; D006801:Humans; D056888:Patient Positioning / Q000379:methods; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial