{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:12:17Z","timestamp":1792098737168,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Elevating the head of bed (HOB) to 30\u00b0 to 45\u00b0 is an evidence\u2010based recommendation to prevent ventilator\u2010associated pneumonia (VAP). However, the available scientific data are inconclusive regarding the optimal degree of HOB elevation which is safe and effective for mechanically ventilated patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims and objectives<\/jats:title><jats:p>To investigate the impact a of semirecumbent position at 30\u00b0 and 45\u00b0on the development of VAP as compared with aHOB elevation to &lt;30\u00b0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A 5\u2010day, single centre, prospective, randomized, controlled, parallel group, three\u2010arm study was conducted in adult patients on mechanical ventilation staying in the intensive care unit. Patients were randomly placed in &lt;30\u00b0, 30\u00b0, or 45\u00b0 HOB elevation position on the day of intubation and followed up for 5\u2009days. They were assessed in terms of the development of microbiologically confirmed VAP (by the culture of endotracheal aspirate) over the study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty patients (20 in each arm) completed the study. VAP occurred in 55%, 25%, and 20% of patients in the HOB elevation to &lt;30\u00b0, 30\u00b0, and 45\u00b0study arms, respectively. The frequency of VAP was significantly lower in the 45\u00b0 compared with the &lt;30\u00b0 study arm (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.022); there were no significant differences between the &lt;30\u00b0 and 30\u00b0 as well as the 45\u00b0 and 30\u00b0 study groups. Unlike the frequency of VAP, the timing of the VAP (early or late) was not dependent on the degree of HOB elevation (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.703).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Keeping the mechanically ventilated patients in a semirecumbent position as close to 45\u00b0as possible should be the goal to prevent the development of VAP. The backrest elevation &lt;30\u00b0 should be avoided unless medically indicated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to clinical practice<\/jats:title><jats:p>The study results reaffirm the crucial role of patient positioning, an essential nursing care intervention, in preventing VAP. Intensive care nurses can contribute to improving the VAP rates and outcomes by placing and keeping the patients in the correct position.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nicc.12633","type":"journal-article","created":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T10:01:08Z","timestamp":1619085668000},"page":"635-645","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Role of <scp>head\u2010of\u2010bed<\/scp> elevation in preventing <scp>ventilator\u2010associated<\/scp> pneumonia bed elevation and pneumonia"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1637-0690","authenticated-orcid":false,"given":"Canan Ka\u015f","family":"G\u00fcner","sequence":"first","affiliation":[{"name":"Medical Documentation and Secretarial Department Medical Services and Techniques Program, Ta\u015fk\u00f6pr\u00fc Vocational School of Higher Education, Kastamonu University  Kastamonu Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevin\u00e7","family":"Kutlut\u00fcrkan","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Nursing Ankara University  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2014.0714"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw504"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-05980-0"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00582-2017"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/677144"},{"issue":"6","key":"e_1_2_11_7_1","first-page":"814","article-title":"Prevention of ventilator\u2010associated pneumonia in the intensive care unit: a review of the clinically relevant recent advancements","volume":"139","author":"Keyt H","year":"2014","journal-title":"Indian J Med Res"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjaed\/mkv046"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-116-7-540"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03510160083034"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)12251-1"},{"issue":"3","key":"e_1_2_11_12_1","first-page":"1","article-title":"Guidelines for preventing health\u2010care\u2010associated pneumonia, 2003: recommendations of CDC and the healthcare infection control practices advisory committee","volume":"53","author":"Tablan OC","year":"2004","journal-title":"MMWR Recomm Rep"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200405-644ST"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2007.11.014"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medin.2013.12.007"},{"key":"e_1_2_11_16_1","unstructured":"T\u00fcrk Toraks Derne\u011fi Eri\u015fkinlerde Hastanede Geli\u015fen Pn\u00f6moni Tan\u0131ve Tedavi Uzla\u015f\u0131 Raporu2018.https:\/\/www.toraks.org.tr\/site\/community\/library\/2298. 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