Southern Illinois University Edwardsville, 62026-1066, USA.
Am J Crit Care. 2010 Jan;19(1):39-47. doi: 10.4037/ajcc2010836.
Patients receiving mechanical ventilation are at high risk for pneumonia due to aspiration. Published guidelines recommend elevating the head of the bed 30 degrees to 45 degrees , if not contraindicated, to reduce risk, but this intervention is underused.
To facilitate incorporating evidence-based practice by improving positioning of patients receiving mechanical ventilation and to identify patient and nurse characteristics that predict use of the guideline.
A modified interrupted time-series design was used. Data were collected on 43 patients and 33 nurses 3 separate times in a 12-bed intensive care unit at a medium-sized hospital. A total of 105 observations were recorded for analysis each time.
Mean elevations of the head of the bed increased significantly from phase 1 (27.7 degrees ) to phase 2 (31.7 degrees ) and from phase 1 to phase 3 (31.1 degrees ). Elevations were higher for tube-fed patients than for patients not given enteral tube feedings. Elevations were higher for patients with a pulmonary-related diagnosis and lower for patients with a gastrointestinal diagnosis than for patients with other diagnoses. Elevations were lower for patients with a body mass index between 25.0 and 29.9 (overweight) than for patients with other body mass index values. Nurse characteristics were not significant predictors of elevation.
A nursing clinical decision support system integrated into a patient's electronic flow sheet can increase nurses' adherence to guidelines. Pulmonary and gastrointestinal diagnoses, body mass index, and tube feeding are predictors of elevation of the head of the bed.
接受机械通气的患者因吸入而面临肺炎的高风险。已发布的指南建议，如果没有禁忌证，将床头抬高 30 度至 45 度，以降低风险，但该干预措施并未得到充分应用。
通过改善接受机械通气患者的体位来促进实施基于证据的实践，并确定预测指南使用情况的患者和护士特征。
采用改良的中断时间序列设计。在一家中等规模医院的 12 张重症监护病房中，对 43 名患者和 33 名护士进行了 3 次独立的研究。每次分析时，共记录了 105 个观察值。
床头抬高的平均值从第 1 阶段（27.7 度）显著增加到第 2 阶段（31.7 度），并从第 1 阶段增加到第 3 阶段（31.1 度）。给予肠内管饲的患者比未给予肠内管饲的患者的床头抬高更高。与其他诊断相比，肺部相关诊断的患者床头抬高更高，胃肠道诊断的患者床头抬高更低。体重指数（BMI）在 25.0 到 29.9 之间（超重）的患者比其他 BMI 值的患者床头抬高更低。护士特征不是床头抬高的显著预测因素。
集成到患者电子病历中的护理临床决策支持系统可以提高护士对指南的遵从性。肺部和胃肠道诊断、BMI 和管饲是床头抬高的预测因素。
