Maintaining head of bed elevation (HOBE) greater than 30° has been shown to decrease the incidence of ventilator associated pneumonia. We prospectively studied the accuracy of clinical estimation of HOBE.
HOBE was set at two levels 30° and 45° with the use of a protractor. Nurses and physicians were asked to determine the HOBE angle. The position of the observer, whether the estimation was performed at the foot or the side of the bed, was evaluated.
One hundred and fifty nurses and fifty physicians participated in the study. Overall, when HOBE was 30°, the average clinical estimation was 50° (P<0.001). When the HOBE was 45°, the average clinical estimation was 70° (P<0.001). When the observer was at the foot of the bed, only 32 (16%) correctly estimated the position versus 90 (45%) of the observers correctly estimated bed position from the side of the bed (P=0.001). There was no difference between physicians and nurses in the accuracy of the clinical estimation of HOBE.
Clinical evaluation of the angle of HOBE tends to overestimate the angle of elevation. Measurement of the HOBE from the side rather than the foot of the bed is more accurate.
Use of protractors rather than clinical estimation should be encouraged to maintain HOBE greater than 30°.
Nasir Awan, None.