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Recommendations Summary

EE: Body Positions in Healthy and Non-Critically Ill 2014

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    EE: Body Positions in Healthy and Non-Critically Ill Adults

    The registered dietitian nutritionist (RDN) should conduct resting metabolic rate (RMR) measurements in a healthy and non-critically ill adult in the supine position when possible. Research indicates that different postures affect RMR. One study of older patients measured prior to an elective thoracotomy reported that RMR was not significantly different in the 30-degree head-of-bed elevation compared to the supine position. In healthy individuals, three studies reported that sitting RMR was greater than supine RMR and standing RMR was greater than sitting RMR.

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      • Fidgeting in any of these positions further increases RMR. Therefore, the RDN must ensure the subject does not fidget during the entire procedure (Levine et al, 2000). 
      • In individuals where the supine position is contraindicated (e.g., cerebral palsy, orthopnea), the RDN should use clinical judgment in determining the best position
      • Clinical judgment should be used in applying this recommendation to healthy and non-critically ill children and to non-critically ill adults, other than elective thoracotomy surgery patients, due to limited evidence in these populations.

    • Potential Costs Associated with Application

      There are no obvious costs that may be associated with the application of this recommendation.

    • Recommendation Narrative

      EE: Body Positions in Healthy and Non-Critically Ill Adults

      • Four studies provide evidence that some postures affect measurement of RMR in healthy and non-critically ill adults
      • One study of older patients, measured prior to undergoing an elective thoracotomy, reported that energy expenditure was not significantly different in the 30-degree head-of-bed elevation than in the supine position
      • In healthy individuals, three studies reported that sitting RMR was greater than supine or lying RMR and standing energy expenditure was greater than sitting or lying RMR. One study demonstrated that fidgeting in any of these positions further increased the RMR.
      • Evidence is based on the following:
        • One positive-quality before and after study (Brandi et al, 1996)
        • One neutral-quality non-randomized clinical trial (Levine et al, 2000)
        • One neutral-quality descriptive study (Sujatha et al, 2000)
        • One neutral-quality diagnostic, validity or reliability study (Taguri et al, 2010).

    • Recommendation Strength Rationale

      Conclusion statement supporting the recommendation is Grade II.

    • Minority Opinions

      None.