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Related Experiment Video

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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient

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Head-of-bed elevation in critically ill patients: a review.

Norma A Metheny¹, Rita A Frantz

¹Saint Louis University School of Nursing, St Louis, MO 63104, USA. methenna@slu.edu

Critical Care Nurse

|June 4, 2013

Summary

Conflicting guidelines on head-of-bed elevation confuse clinicians. Optimal positioning to prevent aspiration and pressure ulcers in critically ill patients requires more research, especially randomized controlled trials.

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Area of Science:

Critical Care Medicine
Patient Safety
Clinical Practice Guidelines

Background:

Conflicting clinical guidelines exist regarding head-of-bed (HOB) elevation for critically ill patients.
HOB elevation is primarily studied for aspiration prevention, with less research on pressure ulcer prevention in this population.
Existing pressure ulcer research often involves non-critically ill individuals, limiting applicability.

Purpose of the Study:

To address the lack of clarity in clinical guidelines for HOB elevation.
To highlight the need for research balancing aspiration and pressure ulcer risks in mechanically ventilated, tube-fed patients.
To identify the optimal HOB position for critically ill patients.

Main Methods:

Review of existing literature on HOB elevation and its effects on aspiration and pressure ulcers.
Analysis of research gaps, particularly in critically ill populations.
Identification of the need for simultaneous evaluation of both outcomes in various HOB positions.

Main Results:

Limited research-based evidence supports current guidelines for HOB elevation.
HOB positioning is more studied for aspiration prevention than pressure ulcer prevention in critical care.
Optimal HOB elevation remains unknown for balancing risks in critically ill patients.

Conclusions:

Current evidence is insufficient to establish definitive guidelines for HOB elevation in critically ill patients.
Randomized controlled trials are needed to evaluate various HOB positions simultaneously for both aspiration and pressure ulcer prevention.
Further research is crucial for optimizing patient positioning and improving outcomes in critical care settings.