Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit

OBJECTIVES: To evaluate head-of-bed elevation (HOBE) compliance in mechanically ventilated (MV) patients during different time periods, in order to identify factors that may influence compliance and to compare direct-observation compliance with checklist-reported compliance. DESIGN AND SETTING: A prospective observational study was carried out in a polyvalent Intensive Care Unit. PATIENTS: All consecutive patients with MV and no contraindication for semi-recumbency were studied. Intervention and variables: HOBE was observed during four periods of one month each for one year, the first period being blinded. HOBE was measured with an electronic device three times daily. Main variables were HOBE, type of airway device, type of bed, nursing shift, day of the week and checklist-reported compliance. No patient characteristics were collected. RESULTS: During the four periods, 2639 observations were collected. Global HOBE compliance was 24.0%, and the median angle head-of-bed elevation (M-HOBE) was 24.0° (IQR 18.8-30.0). HOBE compliance and M-HOBE by periods were as follows: blinded period: 13.8% and 21.1° (IQR 16.3-24.4); period 1: 25.5% and 24.3° (IQR 18.8-30.2); period 2: 22.7% and 24.4° (IQR 18.9-29.6); and period 3: 31.4% and 26.7° (IQR 21.3-32.6) (p < 0.001). An overestimation of 50-60% was found when comparing self-reported compliance using a checklist versus direct-observation compliance (p<0.001). Multivariate logistic regression analysis found the presence of an endotracheal tube (ET) and bed without HOBE measuring device to be independently associated to greater compliance (p < 0.05). Conclusions: Although compliance increased significantly during the study period, it was still not optimal. Checklist-reported compliance significantly overestimated HOBE compliance. The presence of an ET and a bed without HOBE measuring device was associated to greater compliance

OBJETIVOS: Evaluar el cumplimiento de la elevación de la cabecera de la cama (ECC) en pacientes atendidos con ventilación mecánica (MV) durante distintos periodos de tiempo con el fin de identificar los factores que pueden influir sobre el cumplimiento y comparar el cumplimiento evaluado mediante observación directa con el cumplimiento evaluado mediante lista de verificación. DISEÑO Y ÁMBITO: Se llevó a cabo un estudio observacional y prospectivo en una unidad de cuidados intensivos polivalente. PACIENTES: Se estudió a todos los pacientes consecutivos atendidos con MV y en los que no estaba contraindicada la reclinación parcial. Intervención y variables: Se observó la ECC durante 4 periodos de un mes a lo largo de un año, el primero de ellos con enmascaramiento. Se midió la ECC mediante un dispositivo electrónico 3 veces al día. Las variables principales fueron ECC, tipo de dispositivo para las vías respiratorias, tipo de cama, turno de enfermería, día de la semana y cumplimiento notificado mediante lista de verificación. No se recopilaron las características de los pacientes. RESULTADOS: Se recopilaron 2.639 observaciones durante los 4 periodos. La tasa global de cumplimiento con la ECC fue del 24.0%, mientras que la mediana del ángulo de elevación de la cabecera de la cama (M-ECC) fue de 24.0° (IQR 18.8–30.0). El cumplimiento con la ECC y la M-ECC por cada periodo fue: periodo con enmascaramiento: 13.8% y 21.1° (IQR 16.3-24.4); periodo 1: 25.5% y 24.3° (IQR 18.8-30.2); periodo 2: 22.7% y 24.4° (IQR 18.9-29.6); y periodo 3: 31.4% y 26.7° (IQR 21.3-32.6) (p < 0.001). Se observó una sobreestimación del 50-60% al comparar el cumplimiento autoevaluado por medio de una lista de verificación frente al cumplimiento evaluado mediante observación directa (p < 0.001). Un análisis de regresión logística multivariante concluyó que la presencia de un tubo endotraqueal (TE) y de una cama sin dispositivo de medición de ECC se asociaban de manera independiente a un mayor cumplimiento (p < 0.05). CONCLUSIONES: Si bien el cumplimiento aumentó de manera significativa durante el periodo del estudio, seguía sin ser el óptimo. El cumplimiento evaluado mediante lista de verificación sobreestimó de manera significativa el cumplimiento de la ECC. La presencia de un TE y una cama sin dispositivo de medición de ECC se asociaba a un mayor cumplimiento

Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit.

OBJECTIVES: To evaluate head-of-bed elevation (HOBE) compliance in mechanically ventilated (MV) patients during different time periods, in order to identify factors that may influence compliance and to compare direct-observation compliance with checklist-reported compliance. DESIGN AND SETTING: A prospective observational study was carried out in a polyvalent Intensive Care Unit. PATIENTS: All consecutive patients with MV and no contraindication for semi-recumbency were studied. INTERVENTION AND VARIABLES: HOBE was observed during four periods of one month each for one year, the first period being blinded. HOBE was measured with an electronic device three times daily. Main variables were HOBE, type of airway device, type of bed, nursing shift, day of the week and checklist-reported compliance. No patient characteristics were collected. RESULTS: During the four periods, 2639 observations were collected. Global HOBE compliance was 24.0%, and the median angle head-of-bed elevation (M-HOBE) was 24.0° (IQR 18.8-30.0). HOBE compliance and M-HOBE by periods were as follows: blinded period: 13.8% and 21.1° (IQR 16.3-24.4); period 1: 25.5% and 24.3° (IQR 18.8-30.2); period 2: 22.7% and 24.4° (IQR 18.9-29.6); and period 3: 31.4% and 26.7° (IQR 21.3-32.6) (p<0.001). An overestimation of 50-60% was found when comparing self-reported compliance using a checklist versus direct-observation compliance (p<0.001). Multivariate logistic regression analysis found the presence of an endotracheal tube (ET) and bed without HOBE measuring device to be independently associated to greater compliance (p<0.05). CONCLUSIONS: Although compliance increased significantly during the study period, it was still not optimal. Checklist-reported compliance significantly overestimated HOBE compliance. The presence of an ET and a bed without HOBE measuring device was associated to greater compliance.

Evaluación del cumplimiento de la elevación de la cabecera de la cama en pacientes críticamente enfermos sometidos a ventilación mecánica en una unidad de cuidados intensivos polivalente / Evaluation of the compliance with the elevation of the head of the bed in critically ill patients undergoing mechanical ventilation in a polyvalent intensive care unit

Objetivos. Evaluar el cumplimiento de la elevación de la cabecera de la cama (ECC) en pacientes atendidos con ventilación mecánica (MV) durante distintos periodos de tiempo con el fin de identificar losfactores que pueden influir sobre el cumplimientoy comparar el cumplimiento evaluado mediante observación directa con el cumplimiento evaluado mediante lista de verificación...