title: Proxy study on minimizing risk of sacral pressure ulcers while complying with ventilator-associated pneumonia risk reduction guidelines.
abstract: Bed positioning poses a subtle, yet important, tradeoff in the competing needs of hospitalized patients, particularly those susceptible to lower respiratory tract infections and/or pressure ulcers. Although it is widely held that a minimum 30° incline is necessary to mitigate risk of ventilator-acquired pneumonia, it is unclear what effect semirecumbent positioning has on the risk of pressure ulcerations. The authors test several hypotheses with the objective of elucidating the relationship between bed incline, posture, and incline, pursuant to a more evidence-based recommendation for practice in clinical care. To this end, interfacial pressures from 40 healthy subjects were analyzed following observation in both supine and sidelying positions, at shallow (30°) and moderate (45°) bed-angle incline. Summarily, the authors report that supine postures reduce pressure signatures associated with pressure ulceration versus sidelying position: 15% increase area of contact (P = 1.3×10), and 17% decrease in ratio of peak to average pressure (P = 3.1×10). Within supine posture, the authors found significant increases in 4 measures of local pressure, including average pressure (10.4% decrease, P = .005) and coefficient of pressure variation (22.1%, P = 2.2×10) at moderate incline. The authors conclude that supine bed positionings at moderate incline appear to reduce predictors of pressure ulceration.
authors.affiliation: Barbara A. Crane, PhD, PT, is an Associate Professor in the Department of Rehabilitation Sciences at the University of Hartford, West Hartford, Connecticut. Michael Wininger, PhD, is an Assistant Professor in the Department of Rehabilitation Sciences at the University of Hartford, West Hartford, Connecticut; and Statistician of Medicine, Cooperative Studies Program at the Veterans Affairs Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut. Michelle Kunsman, PT, DPT, is an Assistant Professor in the Department of Rehabilitation Sciences at the University of Hartford, West Hartford, Connecticut.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Crane
authors.forename: Michael
authors.initials: M
authors.lastname: Wininger
authors.forename: Michelle
authors.initials: M
authors.lastname: Kunsman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011312:Pressure; D003668:Pressure Ulcer / Q000517:prevention & control*; D040242:Risk Reduction Behavior; D012447:Sacrum; D016683:Supine Position