Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: Conflicting recommendations

Burk, Ruth S.; Grap, Mary Jo

doi:10.1016/j.hrtlng.2012.05.008

Cited by 29 publications

(18 citation statements)

References 66 publications

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“…For instance, to facilitate breathing and/or prevent aspiration and ventilator-associated pneumonia, it is recommended to maintain an elevation of the bed at 30 or higher, i.e. a semiFowler position (Burk & Grap, 2012). In contrast, to prevent pressure ulcers it is recommended to not increase the head of the bed more than 30 so as to minimize the pressure and shear forces over the sacrum and coccyx (NPUAP et al, 2014).…”

Section: A Holistic Approach To Repositioning Patientsmentioning

confidence: 99%

Evaluation of Repositioning in Pressure Ulcer Prevention

Källman¹

2015

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Section: A Holistic Approach To Repositioning Patientsmentioning

confidence: 99%

Evaluation of Repositioning in Pressure Ulcer Prevention

Källman¹

2015

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“…These patients tend to slide down from the Trendelenburg position used for mechanical ventilation and turn over and move frequently, changes that increase the risk for exposure of the back to the forces of friction and shear. 33 In our study, stepwise logistic regression analysis indicated that the following factors were significant independent predictors of HAPUs in ICU patients: diastolic blood pressure, albumin levels, use of mechanical ventilation, fecal incontinence, and the total score on the Braden Scale.…”

Section: Discussionmentioning

confidence: 47%

Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients

Deng

2017

Critical Care Nurse

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Background Assessments of risk for pressure ulcers in critical care patients may not include important predictors. Objective To construct risk-prediction models of hospital-acquired pressure ulcers in intensive care patients and compare the models' predictive validities with validity of the Braden Scale. Methods Data were collected retrospectively on patients admitted to intensive care from October 2011 through October 2013. Logistic regression and decision trees were used to construct the risk-prediction models. Predictive validity was measured by using sensitivity, specificity, positive and negative predictive values, and area under the curve. Results With logistic regression analysis, 6 factors were significant independent predictors. With the decision tree, 4 types of high-risk populations were identified. Predictive validity of Braden Scale scores was lower than the validities of the logistic regression and the decision tree models. Conclusion Risk for hospital-acquired pressure ulcers is overpredicted with the Braden Scale, with low specificity and low positive predictive value. (Critical Care Nurse. 2017;37[4]:e1-e11)

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“…As noted in the literature review by Burk and Grap, 15 backrest elevation has been found to affect interface pressures under the pelvic region. The results of this study are in general agreement …”

Section: Discussionmentioning

confidence: 89%

“…14 In addition, there are a variety of factors beyond patient position that have implications for both pressure ulceration and VAP, but for which the impact on PrU risk has not been well studied. 15 Without undervaluing the importance of reducing risk of VAP, the impact that this guideline has on the prevention and management of PrUs has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Proxy Study on Minimizing Risk of Sacral Pressure Ulcers While Complying with Ventilator-Associated Pneumonia Risk Reduction Guidelines

Crane

Wininger

Kunsman

2015

Advances in Skin &Amp; Wound Care

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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.

show abstract

Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: Conflicting recommendations

Cited by 29 publications

References 66 publications

Evaluation of Repositioning in Pressure Ulcer Prevention

Evaluation of Repositioning in Pressure Ulcer Prevention

Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients

Proxy Study on Minimizing Risk of Sacral Pressure Ulcers While Complying with Ventilator-Associated Pneumonia Risk Reduction Guidelines

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