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Study of the ability of ICU staff to set a bed to the semi-recumbent position

Introduction

The aim of this study was to assess the accuracy of setting the angle of the head of a bed to the semi-recumbent position. Ventilator-acquired pneumonias (VAPs) account for 31% of all ICU infections. Aetiology appears to be aspiration of contaminated oropharyngeal and gastric secretions around the endotracheal tube. The semi-recumbent position compared with the supine position is known to significantly reduce the incidence of VAP (8% vs. 34%) [1]. Hence the National Institute for Clinical Excellence in the UK publishing a recommendation that ventilated patients be nursed at an angle of 30° to 45°.

Methods

Fifty-five members of ICU staff were asked to set the angle of the head of a standard ICU bed to 30° and 45°. The estimated bed angle was then measured accurately using a Mathey Dearman protractor.

Results

When estimating the head of the bed, nursing staff were the most accurate (Table 1) while other staff significantly underestimated the angle of the bed. We also found that greater experience of working in the ICU is likely to improve ability to estimate the angle of the head of bed accurately.

Table 1 Mean estimates

Conclusion

Evidence suggests patients should be nursed in the semi-recumbent position to prevent VAP. However, we have found estimating the angle of a bed by eye is difficult and often inaccurate. Simple aids that highlight the angle of the bed have been shown to improve compliance to the semi-recumbent position by up to 71.5% compared with 21% in one study [2]. Such aids to set the angle of the bed should be introduced in common practice to improve compliance with VAP guidelines.

References

  1. 1.

    Drakulovic MB, et al.: 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

  2. 2.

    Williams Z, et al.: A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients. Crit Care Med 2008, 36: 1155-1157. 10.1097/CCM.0b013e318168fa59

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Keane, M., Kapoor, R. Study of the ability of ICU staff to set a bed to the semi-recumbent position. Crit Care 13, P484 (2009). https://doi.org/10.1186/cc7648

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Keywords

  • Public Health
  • Pneumonia
  • Emergency Medicine
  • Supine Position
  • Endotracheal Tube