Adverse Events Associated With Bed Baths in Mechanically Ventilated Patients

Bed bathing is a routine nursing intervention in intensive care units that can impact patient physiology and safety, yet its effects remain poorly defined.

To assess the physiological changes and adverse events associated with bed bathing in mechanically ventilated patients.

A prospective, non-interventional, analytical cohort study. This study was conducted across six specialised adult intensive care units. Standard soap and water bed bath practice was observed using a standardised checklist, while physiological parameters and specific adverse events were measured across five time points: before, during, immediately after, 15 min after, and 30 min after bed bathing.

Of 211 intensive care unit (ICU) patients screened, 160 mechanically ventilated patients were analysed. Repeated measures analysis of variance (ANOVA) revealed significant physiological changes during bed bath, including increased heart rate (F = 21.85, p < 0.001, η² = 0.121), respiratory rate (F = 43.39, p < 0.001, η² = 0.215), and peak airway pressure (F = 59.08, p < 0.001, η² = 0.271), with concurrent declines in tidal volume (F = 76.14, p < 0.001, η² = 0.324) and transient hypoxaemia (F = 3.69, p = 0.041, η² = 0.023). Pain (68.8%) and agitation (28.1%) were the most frequent adverse events. Random forest analysis identified APACHE II > 20 (+21%, p < 0.001), inotrope use (+23%, p = 0.004), and protocol non-adherence (+16%, p = 0.023) as key predictors of adverse events.

Bed bathing induces significant physiological stress and a frequent incidence of adverse events in mechanically ventilated patients, effects strongly influenced by patient clinical characteristics and nursing adherence. Targeted interventions to improve protocol adherence and training may mitigate these risks.

Monitoring of mechanically ventilated patients during bed baths is essential, especially in high-risk patients with high APACHE II scores and inotrope use. Preemptive pain and agitation management strategies should be considered to minimise the physiological stress of the bed bath procedure.