An evidence-based recommendation on bed head elevation for mechanically ventilated patients

An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Critical Care 2011, 15:R111

Niël-Weise BS, et al.

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 degrees bed head elevation was effective or harmful with regard to the occurrence of clinically suspected ventilator-associated pneumonia (VAP), microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45 degrees 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 degrees position and preferably in a [greater than or equal to] 30 degrees position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes