| ntroduction: Head-of-Bed Elevation (HOBE) is now considered
as a main modifiable factor for decreasing Ventilator-Associated
Pneumonia (VAP) especially in the area of intensive care nursing.
Despite numerous studies on the beneficial effects of different
HOBE, there is little scientific evidence examining the effect of
a 60° HOBE position.
Aim: The present study aimed to examine the effect of 60° HOBE
on preventing VAP and respiratory parameters in mechanically
ventilated patients.
Materials and Methods: In a single-blind prospective
randomised clinical trial, 25 patients were recruited in the
multidisciplinary surgical intensive care unit over a period of a
year (June 2011 to April 2012), and randomly assigned to the
intervention group maintaining position of 60° (n=14) and the
control group in the routine position of 45° (n=11). VAP and
respiratory parameters (tidal volume, pulmonary compliance,
pulmonary resistance, and respiratory rate) were investigated
from first to the seventh day of intubation.
Results: HOBE at 60° resulted in significantly lower pulmonary
infiltration on chest X-ray (p=0.009), lower axillary temperature
(p=0.001), as well as higher tidal volume (p<0.001) and higher
pulmonary compliance (p=0.038) compared with the control group.
The overall prevalence of VAP was 20% in the intervention group
and 73% in the control group (p=0.016). In this regard, HOBE from
45° to 60° reduced the risk of VAP more than three times.
Conclusion: HOBE at 60° results in a significant decrease in the
occurrence of VAP and also improvement in some mechanical
respiratory parameters including tidal volume and pulmonary
complia |