Skip to main content
  • Poster presentation
  • Open access
  • Published:

Preventing ventilator-associated pneumonia: a new methodology for bed head control 24 × 7


Among the measures for preventing ventilator-associated pneumonia (VAP) in patients at risk, strict control of the bed head above 30° stands as the single one with better cost benefit [1]. While the semi-recumbent position is intended to be an inexpensive and easily performed action by the intensive care unit team, the smart beds currently available are not the reality for the vast majority of hospitals around the world because of the high cost. Therefore, the simple theoretical principles for its execution are contradicted by its difficult practical application.


We propose a new methodology for continuous control of the bed head, thus making possible the appropriate compliance to the semi-recumbent position, seeking a reduction in the VAP rates.


A retrospective observational study with 41 mechanically ventilated patients over a 7-month period starting in May 2010, in a neurointensive critical care unit of a private tertiary hospital. There was a historical control as reference during 3 months before the intervention made in August, and measurements for the same time after it as a means to confirm its appropriate implementation, based on the National Nosocomial Infections Surveillance System (NNISS) as a parameter. Applied was a technique for an hourly basis positioning of the head of bed angle in such a manner that it never remained below 30° for over 1 hour in the 24 hours daily. It was turned into a mandatory item in the prescription and its execution was performed by the nursing staff, through reading of a specific angulation marking adhesive in the side head rail, and annotation in the usual sheet for recording the vital signs, followed by the prompt adjustment to the right position. Other items of the institutional bundle of VAP were not modified.


There was a trend towards reduction in the ventilator-associated respiratory infection rate (Figure 1) after the implementation of the methodology, bringing it to zero despite the elevation in device utilization (Figure 2).

Figure 1
figure 1

Ventilator-associated respiratory infection rate per 1,000 days of mechanical ventilation.

Figure 2
figure 2

Device utilization for mechanical ventilation.


This unsophisticated and low-cost method for controlling heads of beds in an intensive care unit allowed its adequate employment, thus seeming to cause an impact in the incidence of VAP when comparing respiratory infection rate and device utilization, despite limitations about the small case series and the short following period.


  1. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999, 354: 1851-1858. 10.1016/S0140-6736(98)12251-1

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Vaz, G., Gonçalves, R. Preventing ventilator-associated pneumonia: a new methodology for bed head control 24 × 7. Crit Care 15 (Suppl 2), P27 (2011).

Download citation

  • Published:

  • DOI: