title: Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit.
abstract: OBJECTIVE
  To evaluate head-of-bed elevation (HOBE) compliance in mechanically ventilated (MV) patients during different time periods, in order to identify factors that may influence compliance and to compare direct-observation compliance with checklist-reported compliance.
  
  
  METHODS
  A prospective observational study was carried out in a polyvalent Intensive Care Unit.
  
  
  METHODS
  All consecutive patients with MV and no contraindication for semi-recumbency were studied.
  HOBE was observed during four periods of one month each for one year, the first period being blinded. HOBE was measured with an electronic device three times daily. Main variables were HOBE, type of airway device, type of bed, nursing shift, day of the week and checklist-reported compliance. No patient characteristics were collected.
  
  
  RESULTS
  During the four periods, 2639 observations were collected. Global HOBE compliance was 24.0%, and the median angle head-of-bed elevation (M-HOBE) was 24.0° (IQR 18.8-30.0). HOBE compliance and M-HOBE by periods were as follows: blinded period: 13.8% and 21.1° (IQR 16.3-24.4); period 1: 25.5% and 24.3° (IQR 18.8-30.2); period 2: 22.7% and 24.4° (IQR 18.9-29.6); and period 3: 31.4% and 26.7° (IQR 21.3-32.6) (p<0.001). An overestimation of 50-60% was found when comparing self-reported compliance using a checklist versus direct-observation compliance (p<0.001). Multivariate logistic regression analysis found the presence of an endotracheal tube (ET) and bed without HOBE measuring device to be independently associated to greater compliance (p<0.05).
  
  
  CONCLUSIONS
  Although compliance increased significantly during the study period, it was still not optimal. Checklist-reported compliance significantly overestimated HOBE compliance. The presence of an ET and a bed without HOBE measuring device was associated to greater compliance.
authors.affiliation: Institut d'investigació Sanitària Pere Virgili, Spain; Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain; Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain. Electronic address: mireiallaurado@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Llaurado-Serra
authors.affiliation: Critical Care Department, Sabadell Hospital, University Institute Parc Taulí - Universitat Autònoma de Barcelona (UAB), Sabadell Spain; Fundació Clínic per la Recerca Biomèdica - Universitat de Barcelona (UB), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ulldemolins
authors.affiliation: Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Güell-Baró
authors.affiliation: Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain; Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Coloma-Gómez
authors.affiliation: Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Alabart-Lorenzo
authors.affiliation: Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: López-Gil
authors.affiliation: Institut d'investigació Sanitària Pere Virgili, Spain; Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain; Medical school, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bodí
authors.affiliation: Institut d'investigació Sanitària Pere Virgili, Spain; Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain; Medical school, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: M F
authors.initials: MF
authors.lastname: Jiménez-Herrera
mesh_terms: D001071:Appointments and Schedules; D001513:Beds; D057189:Checklist; D003422:Critical Care / Q000379:methods / Q000592:standards*; D064648:Critical Care Nursing / Q000592:standards; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D056888:Patient Positioning / Q000592:standards; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods* / Q000451:nursing
keywords: Clinical practice based evidence; Colocación del paciente; Elevación del cabezal de la cama; Head-of-bed elevation; Patient positioning; Práctica clínica basada en la evidencia