Effects of 60 degrees Semi-recumbent Position on Preventing Ventilator-associated Pneumonia: A Single-blind Prospective Randomised Clinical Trial

Abstract

Introduction: 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 degrees HOBE position. Aim: The present study aimed to examine the effect of 60 degrees 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 degrees (n=14) and control group in the routine position of 45 degrees (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 degrees 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 degrees to 60 degrees reduced the risk of VAP more than three times. Conclusion: HOBE at 60 degrees results in a significant decrease in the occurrence of VAP and also improvement in some mechanical respiratory parameters including tidal volume and pulmonary compliance.