From: An evidence-based recommendation on bed head elevation for mechanically ventilated patients
Study | Study participants (number of patients randomized) | Treatment (T) and Control (C) groups (number of patients analyzed) | Duration of ICU ventilation | Outcomes | Baseline risks, % | End of study protocol |
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Drakulovic and colleagues [8] | Respiratory and medical ICU patients (90). Excluded: previous endotracheal intubation (<30 days); recent abdominal surgery; recent neurosurgical intervention; hemodynamic instability | T (39), 45°; C (47), 0°. Correctness of the position was checked once a day | Mean: T, 145 hours (SD 149); C, 171 hours (SD 167) | Clinically suspected VAP, defined as new and persistent infiltrate on chest radiography and at least two of the following three criteria: fever; leucopenia or leucocytosis; purulent tracheal secretions: T, 3/39; C, 16/47 | Clinically suspected VAP: 34% | End of study protocol: (1) first weaning trial, (2) extubation, (3) death, (4) permanent change in body position for more than 45 minutes |
Microbiologically confirmed VAP, defined as clinical suspicion and positive ETS, BAL or PSB: T, 2/39; C, 11/47 | Microbiologically confirmed VAP: 23% | Follow-up for an additional 72 hours after the study end point has been reached | ||||
ICU mortality: T, 7/39; C, 13/47 | For ICU mortality: 28% | |||||
Keeley [19] | Adult ventilated patients with no contraindications for raised head of bed (56). Excluded: previous endotracheal intubation (<30 days); recent abdominal surgery with vacuum dressing; severe obesitas; hemodynamic instability; renal replacement therapy; pregnancy; spinal surgery or trauma | T (17), 45°; C (13), 25°. Authors did not report whether correctness of the position was checked during the study | Meana: T, 3.8 days; C, 5.1 days | Clinically suspected VAP, defined as new and persistent infiltrate on chest radiography and at least two of the following three criteria: fever; leucopenia or leucocytosis; purulent tracheal secretions: T, 1/17; C, 2/13 | Clinically suspected VAP: 15% | End of study protocol: (1) first successful weaning trial, (2) extubation, (3) death |
Microbiologically confirmed VAP, defined as clinical suspicion and positive ETS, BAL or PSB: T, 4/17; C, 5/13 | Microbiologically confirmed VAP: 38% | Follow-up for an additional 72 hours after the study end point has been reached | ||||
In-hospital mortality: T, 5/17; C, 4/13 | In-hospital mortality: 31% | |||||
van Nieuwenhoven and colleagues [20] | Adult ventilated patients with no contraindications for raised head of bed and an expected duration of ventilation >48 hours (221). Excluded: selective decontamination of the digestive tract; trauma of the pelvic region; extensive abdominal surgery; neurosurgical patients treated with 30° head elevation; patients cared for in beds without the possibility of altering backrest elevation | T (112), 45°; C (109), 10°. Backrest elevation was measured every 60 seconds by means of a transducer with pendulum. A dedicated nurse controlled patient position two or three times daily and restored backrest elevation to the randomized position when possible | Median: T, 6 (0 to 281) days; C, 6 (0 to 64) days | Clinically suspected VAP, defined as new or persistent or progressive radiographic infiltrate with at least two of the following criteria: temperature >38°C or <35°C; leucopenia or leucocytosis; positive cultures of tracheal aspirate: T, 16/112; C, 20/109 | Clinically suspected VAP: 18% | End of study protocol: (1) extubation, (2) death, (3) patients were placed in a bed without the possibility to alter backrest elevation, (4) VAP |
Microbiologically confirmed pneumonia, defined as clinical suspicion and positive BAL or positive blood culture with the same microorganisms as in tracheal aspirate: T, 13/11; C, 8/109 | Microbiologically confirmed VAP: 7% | Authors did not report whether there was a follow-up for an additional 72 hours after the study end point has been reached | ||||
ICU mortality: T, 33/112; C, 33/109 | ICU mortality: 30% | |||||
Pressure soreb: T, 31/112c; C, 33/109c | ||||||
Feasibility of the allocated positiond |