title: Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: conflicting recommendations.
abstract: Pressure ulcers and ventilator-associated pneumonia (VAP) are both common in acute and critical care settings and are considerable sources of morbidity, mortality, and health care costs. To prevent pressure ulcers, guidelines limit bed backrest elevation to less than 30 degrees, whereas recommendations to reduce VAP include use of backrest elevations of 30 degrees or more. Although a variety of risk factors beyond patient position have been identified for both pressure ulcers and VAP, this article will focus on summarizing the major evidence for each of these apparently conflicting positioning strategies and discuss implications for practice in managing mechanically ventilated patients with risk factors for both pressure ulcers and VAP.
authors: School of Nursing, Virginia Commonwealth University, Richmond, Virginia 23294, USA. burkrv@vcu.edu
authors: Ruth Srednicki
authors: RS
authors: Burk
authors: Mary Jo
authors: MJ
authors: Grap
mesh_terms: D001513:Beds; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D056888:Patient Positioning / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D003668:Pressure Ulcer / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D016683:Supine Position