Use of backrest elevation in critical care: A pilot study

• BACKGROUND Use of lower backrest positions occurs frequently and is a factor in the development of ventilator-associated pneumonia. • OBJECTIVES To determine the usual bed elevation and backrest position in a medical intensive care unit and their relationship to hemodynamic status and enterai feeding. • METHODS Data were collected in a 12-bed medical respiratory intensive care unit for 2 months. A protractor was used to measure the elevation of the head of the bed. Hemodynamic status was defined by systolic, diastolic, and mean arterial blood pressure measurements retrieved from each patient's flow sheet. • RESULTS The sample included 347 measurements of 52 patients. Mean backrest elevation was 22.9°, and 86% of patients were supine. Backrest position differed significantly (P-.005) among nursing shifts (days, evenings, nights) but not for systolic (r=-0.04, P=.49), diastolic (r = 0.01, P = .83), or mean arterial blood pressure (r=-0.01, P=.84). Backrest elevation did not differ significantly between patients who were receiving enteral feedings and patients who were not (P =.23) or between patients receiving intermittent versus continuous nutrition (P =.22). • CONCLUSIONS Use of higher levels of backrest elevation (>30°) is minimal and is not related to use of enterai feeding or to hemodynamic status. The rationale for using lower backrest positions for critically ill patients may be based on convenience, the patient's comfort, or usual patterns in the unit. However, the dangers of supine positioning and its relationship to aspiration and ventilator-associated pneumonia should not be minimized.