Assessment of head elevation in ventilated patients

Title : Assessment of head elevation in ventilated patients

Abstract:

Background: Ventilator-associated pneumonia (VAP) remains an important complication of mechanical ventilation and is associated with increased morbidity, mortality and healthcare utilisation. Head-of-bed (HOB) elevation is a simple, low-cost intervention incorporated into ventilator care bundles to reduce the risk of pulmonary aspiration and subsequent VAP. The Faculty of Intensive Care Medicine (FICM) and Intensive Care Society (ICS) Guidelines for the Provision of Intensive Care Services (GPICS) recommend that, unless clinically contraindicated, ventilated patients should be nursed in a semi-recumbent position at 30–45°. This recommendation is supported by evidence examining semi-recumbent positioning and is incorporated into broader strategies for VAP prevention.

Aim: To assess compliance with the GPICS recommendation for HOB elevation in intubated, mechanically ventilated patients within an intensive care unit (ITU), and to identify potential barriers to achieving the recommended position.

Methods: A prospective clinical audit will be conducted in an adult ITU. Intubated and mechanically ventilated patients will be assessed for HOB elevation during the audit period. The primary outcome will be the proportion of eligible patients positioned at 30–45°. Where the HOB is below 30°, the presence of a documented clinical contraindication will be recorded. Patients for whom semi-recumbent positioning is clinically inappropriate will be excluded from assessment of compliance. Compliance will be compared against the GPICS recommendation, with results presented as the proportion of eligible observations meeting the 30–45° target.

Conclusion: HOB elevation is a simple intervention that can be incorporated into routine care of mechanically ventilated patients. Auditing adherence to the GPICS 30–45° recommendation provides an opportunity to identify variation in practice and support ongoing quality improvement in VAP prevention.

Biography:

Varunaen Udayachandran an ST3 Emergency Medicine trainee with a strong interest in Critical Care. he particularly interested in the management of critically ill patients and the interface between Emergency Medicine and Intensive Care. he as keen to pursue a career combining both specialties and am hoping to undertake dual training in Emergency Medicine and Intensive Care Medicine. he is enthusiastic about developing his experience in Critical Care and contributing to teaching, quality improvement and clinical research.