The Effect of Head-of-bed Elevation of 45 Degree on the Incidence of Ventilator- Associated Pneumonia among Hospitalized Patients in Intensive Care Units

Abstract

Background & Aim: The prevention of ventilator-associated pneumonia (VAP) can decrease the duration of mechanical ventilation, length of hospital stay, and healthcare costs. One of the interventions is raising the head of bed (HOB) to 45 degrees. This study was perfomed with the aim of determining the effect of the HOB elevation to 45 degree on the incidence of VAP on hospitalized in Intensive Care Unit (ICU). Materials & Methods: This study was a randomized clinical trial. It consisted of 80 patients who were under mechanical ventilation and hospitalized in Intensive Care Unit (ICU) from February to July 2016 in the selected governmental hospitals affiliated to Iran University of Medical Sciences. The samples were assigned to two groups, i.e. control and intervention, using a randomised block method. The patients in intervention and control groups had HOB elevation to 45 degree and routine position for three consecutive days. In both groups, HOB elevation in every shift was measured using the goniometer and was recorded by nurses in the angel of bed form. At the end of the third day, ventilator-associated pneumonia was evaluated, using the Clinical Pulmonary Infection Score (CPIS). Data analysis was performed with chi-square, Fisher's exact test, and T-Test via SPSS v.20. Results: There was a statistically significant difference between two groups with regard to VAP (P-value=0.002). The incidence of VAP were 52.5% in the control group and 20% in the intervention group. Conclusion: According to the results of this study, HOB elevation of 45 degree were effective in preventing VAP. Hence, it is recommended that the patients hospitalized in ICU,and under mechanical ventilation, should be positioned 45 degree according to their conditions.

Multi-criteria risk evaluation model for developing ventilator-associated pneumonia

“…The scientific literature suggests that the likelihood of gastric reflux can be lowered with early and safe enteral feeding protocols (Elke et al 2019 ). Another fundamental measure in VAP prevention is patient positioning, with the suggested head-of-bed elevation between 30° and 45°, unless medically contraindicated (Álvarez Lerma et al 2014 ; Najafi Ghezeljeh et al 2018 ). Additional measures for preventing lung infections in intubated patients customarily include recommended airway management practices such as endotracheal aspiration using closed suction systems, respiratory physiotherapy, cuff shape, hand hygiene and appropriate endotracheal tube materials (Álvarez Lerma et al 2014 ; Kučan et al 2015 ), although in-depth research into the effectiveness of some of these measures is lacking (Coppadoro et al 2019 ).…”