PURPOSE: Semi-recumbent positioning has been shown to decrease the incidence of ventilator-associated pneumonia (VAP), yet patients often do not have the head-of-bed (HOB) consistently elevated. The purpose of this study is to determine whether continuous HOB monitoring utilizing an indicator light increases the amount of time patients on mechanical ventilation have the HOB elevated above 30 degrees.
METHODS: 90 patients on mechanical ventilation were enrolled in this controlled, prospective study. Exclusion criterion was contraindication to semi-recumbent positioning. The first 45 consecutive patients were enrolled in the control group, the next consecutive 45 patients in the intervention group. An electronic sensor attached to the bed frame provided continuous monitoring and recording of HOB angle; whenever HOB was >30 degrees, the sensor activated a light and timer on the monitor device. For the control group, the light was disabled, the monitor stored out of view, and the nursing staff blinded to the time measurements. For the intervention group, connections to the light were enabled and the monitor placed on top of the ventilator, where the light and timer were clearly visible to the nursing staff. To control for a possible training effect, data collection ceased at a maximum of 8,640 ventilator minutes (6 days).
RESULTS: The percentage of time with HOB elevated >30 degrees was significantly greater (p<0.0001) in the intervention group, with a median of 81% (interquartile range 70-91%) versus a median of 17% in the control group (interquartile range 4-51%). The intervention group had modestly longer median total ventilator time than the control group (4.1 days versus 3.0 days, p=0.1 for difference). However analysis of variance showed that while the group assignment remained highly significant (p<0.0001), there was no relationship between total ventilator minutes and percentage of time with HOB >30 degrees (p=0.83).
CONCLUSION: Continuous HOB monitoring utilizing an indicator light significantly increases the time mechanically ventilated patients have the HOB elevated >30 degrees.
CLINICAL IMPLICATIONS: Continuous HOB monitoring may decrease the incidence of VAP by improving compliance with semi-recumbent positioning.
DISCLOSURE: Mitchell Kaye, No Financial Disclosure Information; No Product/Research Disclosure Information