Critical Illness

CI: Monitoring Criteria: Patient Positioning (2006)

• Intervention
  What head elevation is associated with a decreased incidence of aspiration pneumonia in enteral nutrition in critically ill patients?

  • Conclusion

    Critically ill patients placed in a 45-degree head of bed elevation during gastric EN had a decreased incidence of aspiration pneumonia.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What head elevation is associated with a decreased incidence of aspiration pneumonia or reflux in enteral nutrition in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bowton D. Nosocomial pneumonia in the ICU-year 2000 and beyond. Chest 1999; 115(3): 28S-33S.
      • Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: An evidence-based systematic review. Ann Int Med 2003; 138(6): 494-501.
      • Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial. Lancet 1999; 354: 1851-1858.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Ibanez J, Penafiel A, Raurich JM, et al. Gastroesophageal reflux in intubated patients receiving enteral nutrition: Effect of supine and semirecumbent positions. J Parent Ent Nutr 1992; 16:419-422
      • Orozco-Levi M, Torres A, Ferrer M, et al. Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med. 1995; 152:1387-1390.
      • Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiratin of gastric contents in patients receiving mechanical ventilation: The effect of body position. Ann Int Med 1992; 116: 540-543.
  • Search Plan and Results: CI: Monitoring Criteria in Critical Illness 2003
     
  What head elevation is associated with decreased incidence of reflux in enteral nutrition in critically ill patients?

  • Conclusion

    Critically ill patients placed in a 45-degree head of bed elevation during gastric EN feeding had a decreased incidence of reflux of gastric contents into pharynx and esophagus.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What head elevation is associated with a decreased incidence of aspiration pneumonia or reflux in enteral nutrition in critically ill patients?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bowton D. Nosocomial pneumonia in the ICU-year 2000 and beyond. Chest 1999; 115(3): 28S-33S.
      • Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: An evidence-based systematic review. Ann Int Med 2003; 138(6): 494-501.
      • Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial. Lancet 1999; 354: 1851-1858.
      • Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN. 2003; 27: 355-373.
      • Ibanez J, Penafiel A, Raurich JM, et al. Gastroesophageal reflux in intubated patients receiving enteral nutrition: Effect of supine and semirecumbent positions. J Parent Ent Nutr 1992; 16:419-422
      • Orozco-Levi M, Torres A, Ferrer M, et al. Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med. 1995; 152:1387-1390.
      • Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiratin of gastric contents in patients receiving mechanical ventilation: The effect of body position. Ann Int Med 1992; 116: 540-543.
  • Search Plan and Results: CI: Monitoring Criteria in Critical Illness 2003