Review Paper: The Bed Incline and Prevention of Ventilator-Associated Pneumonia

Abstract

Background: Ventilator-Associated Pneumonia (VAP) is the most common nosocomial\r(hospital acquired) infection among patients undergoing mechanical ventilation. It increases\rmortality rate, duration of mechanical intubated ventilation, and hospitalization in the Intensive\rCare Units (ICUs). This review study aims to determine the proper gradient of a hospital bed in\rpreventing VAP in patients hospitalized in ICUs.\rMethods: In this study, research articles published from 1999 to 2016 were searched in PubMed,\rScience Direct, SID, and library sources, using keywords of “ventilator-associated pneumonia”\rand “elevated bed incline” and their corresponding terms in the Persian language.\rResults: Results of the review showed that limited studies have been conducted on comparing\rthe different inclines of bed and their effects on preventing VAP. Also, the available studies had\rmethodological limitations or hospital staff failed to keep the patient in the same bed incline\rwhich was under the study for prolonged duration. Based on 19 reviewed studies, the incidence\rof VAP, hospital costs, mortality rate, and duration of mechanical ventilation in patients whose\rbeds were inclined at 45 degrees or 30-45 degrees were significantly lower compared to patients\rreclining in the supine position. Although, in most conducted studies there were no consensus\rover a suitable bed incline in prevention of VAP and bedsore.\rConclusion: Raising the incline of bed can play a role in lowering the incidence of VAP, mortality\rrate, hospital costs and duration of mechanical ventilation. However, the proper gradient is not\rdefinite and requires studies with proper methodology in this regard.