Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation

Mary Jo Grap; Cindy L Munro; Paul A Wetzel; Christine M Schubert; Anathea Pepperl; Ruth S Burk; Valentina Lucas

doi:10.4037/ajcc2016317

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Journal article

Open access

Peer reviewed

Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation

Mary Jo Grap, Cindy L Munro, Paul A Wetzel, Christine M Schubert, Anathea Pepperl, Ruth S Burk and Valentina Lucas

American journal of critical care, Vol.25(3), pp.e56-e63

2016-05

DOI: https://doi.org/10.4037/ajcc2016317

PMCID: PMC5539907

PMID: 27134239

Abstract

Critical Care - methods

Female

Humans

Longitudinal Studies

Male

Middle Aged

Patient Positioning - methods

Pneumonia, Ventilator-Associated - prevention & control

Pressure Ulcer - prevention & control

Respiration, Artificial

Sacrococcygeal Region

Backrest elevations less than 30° are recommended to reduce pressure ulcers, but positions greater than 30° are recommended during mechanical ventilation to reduce risk for ventilator-associated pneumonia. Interface pressure may vary with level of backrest elevation and anatomical location (eg, sacrum, heels). To describe backrest elevation and anatomical location and intensity of skin pressure across the body in patients receiving mechanical ventilation. In a longitudinal study, patients from 3 adult intensive care units in a single institution receiving mechanical ventilation were enrolled within 24 hours of intubation from February 2010 through May 2012. Backrest elevation (by inclinometer) and pressure (by a pressure-mapping system) were measured continuously for 72 hours. Mean tissue interface pressure was determined for 7 anatomical areas: left and right scapula, left and right trochanter, sacrum, and left and right heel. Data on 133 patients were analyzed. For each 1° increase in backrest elevation, mean interface pressure decreased 0.09 to 0.42 mm Hg. For each unit increase in body mass index, mean trochanter pressure increased 0.22 to 0.24 mm Hg. Knee angle (lower extremity bent at the knee) and mobility were time-varying covariates in models of the relationship between backrest elevation and tissue interface pressure. Individual factors such as patient movement and body mass index may be important elements related to risk for pressure ulcers and ventilator-associated pneumonia, and a more nuanced approach in which positioning decisions are tailored to optimize outcomes for individual patients appears warranted.

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.266 Wounds & Ulcers; 1.266.1068 Pressure Ulcer
Web Of Science research areas: Critical Care Medicine; Nursing
ESI research areas: Clinical Medicine

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Details

Title: Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation
Creators: Mary Jo Grap - Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio. mjgrap@vcu.edu
Cindy L Munro - Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
Paul A Wetzel - Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
Christine M Schubert - Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
Anathea Pepperl - Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
Ruth S Burk - Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
Valentina Lucas - Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
Publication Details: American journal of critical care, Vol.25(3), pp.e56-e63
Grant note: R01 NR010381 / NINR NIH HHS R01 NR009506 / NINR NIH HHS
Academic Unit: School of Nursing & Health Studies; School of Nursing & Health Studies Administration
Language: English
Resource Type: Journal article
PMID: 27134239
PMCID: PMC5539907
Record Identifier: 991031613884402976