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Predictors of backrest elevation in critical care
Mary Jo Grap1, Cindy L Munro, Sandra Bryant
1Virginia Commonwealth University School of Nursing, P.O. Box 980567, Richmond, VA 23298-0567, USA. mjgrap@vcu.edu
Intensive & Critical Care Nursing
|April 23, 2003
Summary
Most intensive care unit patients remain in low backrest positions, increasing risks like ventilator-associated pneumonia (VAP). Higher backrest elevation is minimally used and not linked to feeding, but slightly correlates with blood pressure. Strategies are needed to improve adherence to recommended head-of-bed elevation.
Area of Science:
- Critical Care Medicine
- Nursing Research
- Patient Safety
Background:
- Low backrest and supine positions are linked to increased mortality and ventilator-associated pneumonia (VAP).
- Limited data exist on backrest positioning practices and their relationship with enteral feeding and hemodynamic status across different intensive care unit (ICU) settings.
Purpose of the Study:
- To document the level of backrest elevation and position in medical, surgical, and neuroscience ICUs.
- To identify factors associated with and predict patient positioning in ICUs.
Main Methods:
- A descriptive study involving 506 observations of 170 patients over 6 weeks.
- Backrest elevation measured electronically or via gauge; blood pressure (BP), heart rate (HR), and enteral feeding status recorded from medical records.
Main Results:
- Mean backrest elevation was 19.2 degrees, with 70% of patients supine; no significant differences were found among ICU types.
- Significant correlations noted between backrest elevation and systolic BP (r=0.15) and diastolic BP (r=0.13).
- No difference in elevation between fed and non-fed patients; intubated patients trended towards lower elevations (P=0.07).
Conclusions:
- Higher backrest elevations (>30 degrees) are minimally utilized and not associated with feeding status.
- Backrest elevation shows minimal relationship with hemodynamic status.
- Strategies incorporating feedback on nurse's use of backrest elevation are necessary to achieve recommended 30-45 degree elevations.