Respiratory therapy for removing bronchial secretions in mechanically ventilated adult patients

Quintana, Adriana Ribeiro Gonçalves; Atallah, Álvaro Nagib; Saconato, Humberto; Wale, Janet; Melnik, Tamara

doi:10.1002/14651858.cd010317

Cited by 1 publication

(1 citation statement)

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“…There are an estimated 250,000 to 300,000 cases per year in the United States alone, with incidence rates of 5 to 10 per 1000 hospitalizations 67,68 (with those on prolonged ventilation or late-onset pneumonia showing up to a 50% increase in relative risk of mortality in case-control comparisons) 69,70 and estimates of the cost of care near $50,000. 71,72 Furthermore, PrUs affect approximately 3 million adults, with 250,000 to 500,000 hospitalizations per year, costing an average of charge per stay of $37,800.…”

Section: Discussionmentioning

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.

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