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Learning Objective 1: the learner will be able to know how to monitor patient' bed angel
Learning Objective 2: the learner will be able to know the effect of head of bed on preventing the ventilator associated pneumonia
A quasi-experimental design study was conducted in a 42-bed medical-surgical ICU in a medical center in Taiwan. Critically ill patient who need mechanical ventilation greater than 2days and meet the selection criteria was recruited. There were fifty-four patients in experimental group and forty-seven patients in control group. Standard care includes change position every 2 hours with sequence of supine, left lateral, supine, right lateral (experiment group). Study intervention includes keeping patient’s head of bed (HOB) >30 degree and with standard care (control group). Study instruments were demographic data sheet, VAP risk assessment sheet, backrest elevation angel continuously monitoring system. The primary outcome in this study was VAP incidence rate; secondary outcomes were HOB complication (pressure sores), extubation rate at day 28 and mortality. All demographic data, measurement scores, and outcome variables data were entered into SPSS 17.0.
The VAP rate in the experimental group was significant lower than control group (3/54 vs 9/47, p=.035). However, there was no significant difference between two groups in pressure sores (9/54 vs 9/47, p=.35), extubation rates at day 28 (31/21 vs 28/19, p=.226), and mortality (14/54 vs 8/47, p=.543). The major reasons for HOB< 30 degree in two groups were patients’ demanded (54.7%), blood pressure <90 mmHg (26.7%), agitation (7.8%).
Conclusions: This study designed target bed elevation of >30 degrees for critically ill patients that has proved its effectiveness in reducing VAP rate.
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