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:
Most patients tolerated higher elevations, but 3 patients requested HOB lowered from 45°.
No pressure ulcers were identified during the study or 48 hours after.
Overall 44% of oral and 62% of tracheal secretions were positive for pepsin.
As sedation deepened, the percentage of pepsin-positive oral secretions increased.
As the mean HOB angle decreased, the percentage of pepsin–positive oral secretions increased.
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...