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...

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