Ahead-of-bed (HOB) elevation greater than 30° is recommended to prevent ventilator-associated pneumonia and reduce the risk of aspiration. Yet, risk for pressure ulcers is considered higher with HOB greater than 30°. Schallom and colleagues compared the effect of HOB elevations of 30° and 45° on aspiration and pressure ulcer development. They identified the following:
The authors suggest HOB elevation greater than 30° is acceptable to reduce risks in gastric-fed patients using mechanical ventilation. However, these results are based on a sample of 11 patients over a 36-hour period and further testing with pepsin measured (vs presence) is recommended.
—Elisabeth George,rn, phd
See Article, pp 57–66
Clinicians may think of fever as “bad” and would consider interventions to reduce a patient’s elevated temperature. Schell-Chaple and colleagues conducted a secondary analysis of temperature using patients from the ARDS Network and found the following:
Thus, fever may serve a purpose...